SME - Claims Operations (Cantonese Speaker)

2 weeks ago

Kuala Lumpur, Kuala Lumpur, Malaysia Cognizant Technology Solutions Full time

Summary of the Role:

The Subject Matter Expert is responsible for daily claim processing and evaluating medical insurance claims to ensure accuracy, compliance, and timely resolution. The role involves reviewing documentation, verifying coverage and communicating with their seniors to facilitate smooth claim processing.

List of Duties:

  • Assess medical claims in compliance with the terms and conditions of the policy
  • Verify medical codes, diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9, ICD 10, CPT)
  • Escalate enquiries and complex cases to Senior when necessary, in line with internal guidelines
  • Process claims payment in accordance with the company's objectives and guideline
  • Prepare claim communication letter

Desired Professional Experience:

  • With 1 - 4 years of experience in medical claims handling
  • With healthcare background is preferred
  • With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance policies is preferred
  • Strong team player, willing to learn, able to work independently and effectively under pressure
  • Fluent in Cantonese, Mandarin, and English (speak, read, and write).

About Cognizant:

Cognizant (Nasdaq: CTSH) engineers' modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at or @cognizant.

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