Overview
|
Job-type |
Full-Time |
|
Job Category |
Insurance |
|
Industries |
Acc & Finance |
|
Salary |
MYR 5,500
- 6,600
/Month
|
Who you'll be working for
The client is a UK company working in the HK insurance market.
What requirements you'll need to be eligible
-
With 3-5 years of experience in Pre-authorization or medical claims processing.
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With Healthcare background is preferred.
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With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance policies is preferred.
-
Good time management skill and ability to multitask.
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Good knowledge in Claims Management System.
- Minimum high school graduate.
- Fluency in reading and writing mandarin.
What you'll be doing on the job
The Case Management SPE/SME is responsible for complex Pre-Authorization process mainly for day cases & hospital cases and provide guidance to junior advisors and new joiners to ensure high standards of accuracy and efficiency in Pre-authorization process. This role also needs to focus on the high charges cases and N&C will be applied if necessary.
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Review and process complex pre-authorization cases, particularly for day-case and hospital cases, ensuring alignment with policy guidelines and service standards.
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Mentor a team of Pre-Authorization Advisors, providing technical guidance, coaching, and support on challenging cases to ensure consistent decision-making.
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Review and validate pre-authorization decisions made by junior team members, ensuring compliance with internal guidelines and quality benchmarks.
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Collaborate with service providers and internal teams, including Provider Relations, to resolve inquiries and ensure smooth coordination of hospitalization and surgical services.
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Maintain accurate and up-to date documentation in the Claims Management System, supporting audit readiness and data integrity.
Consultant Contact
Sound interesting?
Apply!
