Medical Claims, Team Lead

Hunters International Sdn BhdPetaling Jaya, Selangor, Malaysia

4 days ago

Job description

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

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Team Lead • Petaling Jaya, Selangor, Malaysia