Medical Claims, Team Lead

1 day ago

Petaling Jaya, Selangor, Malaysia Hunters International Full time 4,500 - 6,000 per year


Job Responsibilities

Case Management, Client & Customer Services

  • To provide advice, sound judgment and recommendation on case that surpasses the authority of a Senior Officer. Provide
    advice with appropriate referrals/ escalations as and when needed.
  • To authorize, deny and determine extent of insurers liability on case of discharge that surpasses the authority of a Senior
    Officer.
  • To ensure claims recommendations and decisions are complied with legal requirements, industry regulations, company policies and professional codes. To report to Manager of any claims fraudulent.
  • To assist manager on establish strategies to manage the cost of health insurance. Ensure cost containment is practiced when adjudicating claims.
  • Performing internal audit on claim assessment accuracy by recording errors notice in claim audit sheet.
  • Prepare and analyze audit results, provide improvement suggestion to manager.
  • Ensure no delay in the provision of services and cases to be closed in a timely manner within the agreed SLA.
  • Execute SOPs, best practices, ISO policies and ensure compliance with policies. This shall include compliance of legislative requirement such as data protection and medical confidentiality.
  • Ensure internal customer requests / inquiries for retrieval of claim documents are well attended on timely manner.
  • Respond to clients enquiries via phone calls, e-mails and faxes within agreed client SLA, offering appropriate solutions and information.
  • To cross- expose to any other areas/ team intra or inter department, to take up any other tasks as deemed fit or as assigned by the reporting supervisor when needed.

System, Infrastructure Maintenance & Risk Management

  • To report faulty to manager and work closely with IT for the maintenance and upkeep of systems ensuring day- to- day
    operation runs smoothly without interruption.
  • To be responsible for the readiness, reliability and stability of systems and systems related operating facilities.
  • To involve in risk management, which includes analyzing, identifying, evaluating and estimating the risks which may affect the continuity of business.
  • To work closely with Manager to execute and initiate Business Continuity Plans (BCP).

Job Requirements

  • Degree in Science/Nursing/ Medical bioscience or related field.
  • Experience in Medical Claim services.
  • Good spoken and written communication skills are necessary for daily contact with customers, providers and inter-offices.
  • Proficient in both spoken and written English, Bahasa Malaysia.

Remuneration

  • RM4,500

Consultant In Charge

  • Ashley Yuen | |

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