Claims Processor - Cantonese

Job Title : Processor Role (Claims Operations) - Cantonese

Job 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.
• Communicate effectively across multiple channels, including phone, e-mail, chat, and text.
• Collect information from customers to set up a new claim succinctly.
• 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 the compliance team.
• Maintain turnaround time (TAT) and service level agreements (SLAs) for claims processing.
• Respond to internal queries related to claim status and documentation.
• Ensure compliance 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

Seniority level

Employment type

Job function

Industries

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