CLAIMS ASSESSOR SPECIALIST

Summary

The role of a Claims Executive is to process all the submission claims received from members, corporates or hospital within the turnaround time, to clarify information and to provide solutions and/or alternatives to members, corporates and hospital. Ensure to process the claims and GL related accurately and correctly within the targeted turnaround time, ensuring good service, correct information and good understanding is provided to the members, hospitals and corporate. Handle all document related with the claims and manage the filing system systematically.

Job Responsibilities:

• Provide

expertise or general support by reviewing, researching, investigating, and processing claims

• Process Guarantee Letter (inpatient or outpatient)

application, top-up and final Guarantee Letter

• Process requests and investigative queries for guarantee

letter(s) based on patient medical report, laboratory test results, etc.

• Handle queries of claims from members, corporates and

hospitals via phone and email

• Handle incoming cases/calls for hospital admission and

discharge processes for patients in local

• Resolve any technical or contentious claims within the

boundaries of medical knowledge and policy held

• Prepare any and all necessary documentation(s) for customers'

best experience.

• Paperwork and administrative work including filling and etc
• Any ad hoc task if required

Job Requirements:

• Diploma/Degree

holders from any medical-related fields (Medicine, Nursing, Biomedicine, Bioscience, etc) are preferred

• Fresh

graduates are encouraged to apply

• Adaptable

and able to work on own with minimal supervision

• A high

level of organisational and inter-personal skills

• High

attention to detail

• Able to

converse, read and write in English and Bahasa Malaysia fluently

• Customer

service and result oriented

• Able to

work on shift/odd hours/weekends