Medical Claims Executive

1 week ago

Subang Jaya Selangor, Malaysia PMCare Sdn Bhd Full time

About the role

We are seeking a diligent and detail-oriented Medical Claims Executive to join our team at PMCare Sdn Bhd on a contract basis. In this role, you will be responsible for managing the processing and resolution of medical insurance claims, ensuring accurate and efficient claims handling. You will work from our office located in Subang Jaya, Selangor.

What you'll be doing

  • Review medical claims and supporting documentation to ensure accuracy and completeness
  • Review incoming hospital discharge bills (RM 20,000 above)- medical supplies, medications, tests, and procedures in relation to diagnosis.
  • Propose procedure fees as per the fees stipulated in the 13th schedule, and MMA 5th schedule.
  • Write email/appeal to insurance companies for approval of tests/procedures/diagnosis.
  • Write email to MOH for clarification of procedures not available in 13th schedule and MMA 5th schedule.
  • Respond to email from internal departments (Customer Service department (CSD), Admission GL, Marketing, etc) seeking medical advice relating to patients schedule of benefit.
  • Write questionnaire (QA) to hospital to clarify regarding discrepancy charges in medical discharge bill.
  • Review complicated medical claims.
  • Provide excellent customer service to both internal and external stakeholders
  • Continuously improve claims handling processes and procedures

What we're looking for

  • Candidate must possess at Bachelor's Degree or Professional Certificate in Medical (MBBS), Nursing/Pharmacy/Insurance or any related field
  • Candidate with technical knowledge of medical claims or relevant working experience in Third Party Administration (TPA) / Insurance Industry will be an added advantage
  • Minimum 2 years of experience in medical claims processing or a related field
  • Strong attention to detail and excellent data entry skills
  • Good communication and interpersonal skills
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook)
  • Familiarity with medical terminology and insurance regulations
  • Ability to work well in a team and adapt to changing priorities
  • No plan to apply/reapply to housemanship.

What we offer

At PMCare Sdn Bhd, we are committed to providing a supportive and collaborative work environment. We offer competitive compensation, opportunities for career development, and a range of employee benefits to support your overall well-being.

If you are interested in this exciting opportunity, please apply now.

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