CLAIMS EXECUTIVE / ASSISTANT

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 clients
• Prepare claims borderaux for submission to client/ Finance Department together with the complied supporting documents
• Ensure timely submission of claims and monitor closely on claims settlement timeline.
• Prepare performance report & productivity report as required
• Attend to inquiries with regards to claims operating procedures at CompuMed
• Deliver 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, GL & 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 experience
• Knowledge of insurance/medical terminologies and insurance policy.
• Working experience in healthcare, insurance or similar capacity.
• High level of work commitment and strong sense of responsibility
• Good understanding of medical insurance policies and it application is an added advantage
• Good spoken and written communication skills in Bahasa Malaysia & English
• Those with medical/life insurance claims, hospital services, and clinical services experience
• Knowledge of insurance/medical terminologies and insurance policy.
• Communication and interpersonal skills.
• Computer Literate
• Working experience in TPA, insurance or healthcare industry