Claims Specialist

1 week ago


Subang Jaya, Selangor, Malaysia HealthMetrics Full time

Summary

The role of a Claims Specialist is to process all the submission claims received from members, corporates, or hospitals within the turnaround time, to clarify information and to provide solutions and/or alternatives to members, corporates, and hospitals. Ensure to process the claims and GL related accurately and correctly within the targeted turnaround time, ensuring good service, correct information, and good understanding is provided to the members, hospitals, and corporates. Handle all documents related to the claims and manage the filing system systematically.

Responsibilities

  • Provide expertise or general support by reviewing, researching, investigating, and processing claims.
  • Process Guarantee Letter (inpatient or outpatient) application, top-up, and final Guarantee Letter.
  • Process requests and investigative queries for guarantee letter(s) based on patient medical report, laboratory test results, etc.
  • Handle queries of claims from members, corporates, and hospitals via phone and email.
  • Handle incoming cases/calls for hospital admission and discharge processes for patients locally.
  • Resolve any technical or contentious claims within the boundaries of medical knowledge and policy held.
  • Prepare any and all necessary documentation(s) for customers' best experience.
  • Paperwork and administrative work including filing and other related tasks.
  • Any ad hoc task if required.

Job Requirements:

  • Diploma/Degree holders from any medical-related fields (Medicine, Nursing, Biomedicine, Bioscience, etc.) are preferred.
  • Fresh graduates are encouraged to apply.
  • Adaptable and able to work on own with minimal supervision.
  • A high level of organisational and interpersonal skills.
  • High attention to detail.
  • Able to converse, read, and write in English and Bahasa Malaysia fluently.
  • Customer service and result-oriented.
  • Able to work on shifts/odd hours/weekends.
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