Processor (Claims Operations)

Responsibilities

and Expectations :

• Process health insurance claims in accordance with Hong Kong's Insurance Authority (IA) regulations.
• Verify policyholder eligibility and coverage details before claim adjudication.
• Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines
• Ability tomunicate effectively across multiple channels, including phone, e-mail, chat, and text
• Ability to succinctly collect information from a customer to set up a new claim
• Ability to gather information from multiple source systems to understand and articulate the status of a claim - and what information may be needed, next steps in processing, etc.
• Ensure accurate data entry and documentation of claim details in the system.
• Coordinate with healthcare providers to validate treatment and billing information.
• Identify and escalate potential fraud or abuse cases to thepliance team.
• Maintain turnaround time (TAT) and service level agreements (SLAs) for claims processing.
• Respond to internal queries related to claim status and documentation.
• Ensurepliance with internal SOPs and regulatory standards.
• Support audits by providing required documentation and clarifications.
• Participate in training sessions on regulatory updates and system enhancements.
• Maintain confidentiality and data privacy in handling sensitive health information.
• Collaborate with customer service teams to resolve member inquiries.

Academic and Additional Qualifications Needed :

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 cognizant or @cognizant .

Job ID 46238