JOB SCOPE (Major Responsibilities of this job)
To adjudicate claims for admission, outpatient and major claims.Compile supporting documents as attachment (including police report for MVA and assault claims) with each claim submission to relevant clientsPrepare claims borderaux for submission to client/ Finance Department together with the complied supporting documentsEnsure timely submission of claims and monitor closely on claims settlement timeline.Prepare performance report & productivity report as requiredAttend to inquiries with regards to claims operating procedures at CompuMedDeliver quality customer service and appropriate solutions with regards to medical/insurance claims and clinical services issues.Provide a polite, professional and accurate response in accordance with the agreed service standards.Liaise with hospital personnel with regards to the management of a member during pre-hospitalization, hospitalization and post hospitalization.Prepare complete documents for submission of claims to the insurance company.Update the status of members during hospitalization.Attend to inquiries from insurance companies and service providers with regards the Company's operating procedures.Attend to inquiries and liaise with members regarding reimbursement procedures.Assist the Call Centre Team and support to the new recruits in the Company.Subject to working night shifts and abiding to the duty roster prepared by the Management.Approval of simple claims during and after office hours.Prepare Payment Notice, Guarantee Letter & Decline Letter in daily course of duties.Perform relief task as and when required by the Management.Maintain a proper filing system. JOB SPECIFICATION
At least STPM/ "A" Level/ Pre-U /Diploma/Degree or equivalent in any field.Those with medical/life insurance claims, hospital services, and clinical services experienceKnowledge of insurance/medical terminologies and insurance policy.Working experience in healthcare, insurance or similar capacity.High level of work commitment and strong sense of responsibilityGood understanding of medical insurance policies and it application is an added advantageGood spoken and written communication skills in Bahasa Malaysia & EnglishThose with medical/life insurance claims, hospital services, and clinical services experienceKnowledge of insurance/medical terminologies and insurance policy.Communication and interpersonal skills.Computer LiterateWorking experience in TPA, insurance or healthcare industry