Executive- Claims Analyst - Leading Industry Pay

Key Responsibilities

1. To perform medical insurance claims assessment according to the Health Insurance and Medical guidelines, rules, and regulations of the Health Insurance Policy, Plan, and Benefits.
2. To assess the legal implications, and potential risks and protect our client’s interest.
3. To ensure that all claims are paid in a timely and accurate manner.
4. To investigate claims through liaison with relevant parties to determine the validity of the claims and liability of the insurer.
5. Accountable on daily operations in order to meet or exceed productivity or service standards as defined by Management in line with department or team goals.
6. Process all incoming requests within the service standard and ensure all processes are done prudently and in accordance with all regulatory and corporate requirements.
7. The claims analysts will review billing information for correctness and completeness. The analyst reviews medical billings for the reasonableness of tests, procedures, and hospital stays.
8. The analyst refers to medical claims for further investigation when more information is necessary or when claims are not medically reasonable. Medical claims may require additional documentation or investigation before the payment guarantee is confirmed.
9. Analysts review incurred claims to ensure accuracy. The analyst identifies inaccuracies of incurred claims and works with the necessary party to resolve claims incurred in error.
10. Responsible for all incoming and outgoing calls as a procedure for each claims experience
11. Manage time and be able to work on shifts, guided by the team managers on a 24/7 service level deliverables
12. Meet company KPIs on a monthly and yearly basis where applicable.

Minimum Requirements:

1. Minimum Diploma in Nursing or any other Medical Related Allied Health qualification.
2. Candidates with Medical Degrees will be an added advantage.
3. Working experience in Healthcare, Insurance, TPA, or related fields will be an advantage.
4. Must be computer literate and have a good command of English and Bahasa Malaysia. Literacy in other languages would be an advantage.
5. Have a good foundation in delivering quality service to customers.
6. Knowledge of medical terminologies especially Disease and Treatment will be an advantage.
7. High motivation and must be a strong team player, able to manage stress management and willing to work flexible hours.
8. Applicants should be Malaysian citizens or hold relevant residence status.
9. 24/7 Shift working hours including Public Holidays
10. Candidate/s with Call Centre/Contact/Service Desk center experience will be an advantage.
11. Fresh graduates are encouraged to apply.