Operation Medical Claim Executive

2 weeks ago


Bangsar South, Malaysia Life Care Diagnostic Medical Centre Sdn Bhd Full time

Medical Claims
- Manages routine daily claims administration work.
- Coordinates work flow & meet deadlines.
- Evaluates claims with regards to eligibility.
- Takes decisions on high-cost and complicated cases based on standard operating procedures.
- Coordinates with providers for direct billing.
- Makes suggestions to improve service.
- Increases efficiency, minimizes errors and administration time.

Job Summary:
The Medical Claims Executive Officer is responsible for overseeing and managing the medical claims process within a healthcare organization. This role involves ensuring that claims are processed accurately, efficiently, and in compliance with regulatory requirements. The Executive Officer collaborates with various stakeholders, including medical providers, insurance companies, and internal teams, to resolve claims-related issues and optimize reimbursement.

Key Responsibilities:
Develop and implement strategies to streamline the medical claims process and enhance efficiency.

Oversee the claims adjudication process, ensuring accuracy and compliance with contractual obligations and regulatory guidelines.

Manage a team of claims processors and coordinators, providing guidance, training, and performance feedback.

Monitor claims metrics and key performance indicators to identify trends, patterns, and areas for improvement.

Collaborate with internal departments, such as finance, billing, and compliance, to resolve claims-related issues and optimize revenue cycle management.

Establish and maintain relationships with external stakeholders, including medical providers, insurance companies, and government agencies.

Stay updated on industry trends, changes in regulations, and best practices related to medical claims processing.

Lead initiatives to enhance automation, technology utilization, and process optimization in claims management.

Review and approve complex or high-value claims, ensuring accuracy and adherence to established guidelines.

Serve as a point of escalation for claims disputes or appeals, facilitating resolution and ensuring customer satisfaction.

Qualifications:
Diploma in administration, Bachelor's degree in healthcare administration, business management, or a related field; advanced degree preferred.

Minimum of 2 years of experience in medical claims management, with progressively increasing levels of responsibility.

Strong understanding of medical billing and coding principles, insurance terminology, and healthcare reimbursement methodologies.

Knowledge of regulatory requirements related to claims processing, including HIPAA, CMS guidelines, and state insurance regulations.

Excellent leadership skills, with the ability to inspire and motivate a team to achieve performance goals.

Analytical mindset, with the ability to interpret data, identify trends, and make data-driven decisions.

Effective communication and interpersonal skills, with the ability to collaborate with diverse stakeholders and resolve conflicts diplomatically.

Strong organizational skills and attention to detail, with the ability to prioritize tasks and meet deadlines in a fast-paced environment.

This job description outlines the primary responsibilities and qualifications for the role of Medical Claims Executive Officer. Specific duties and requirements may vary depending on the organization's size, structure, and industry regulations.

**Salary**: RM2,500.00 - RM3,500.00 per month

**Benefits**:

- Additional leave
- Maternity leave
- Opportunities for promotion
- Professional development

Supplemental pay types:

- Commission pay

Ability to Commute:

- Bangsar South (required)

Ability to Relocate:

- Bangsar South: Relocate before starting work (required)


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