Claims Assessor (I-City, Shah Alam)

MiCARE Group; Selangor; On-site; MYR 100,000 - 150,000; Full time

Job summary

A healthcare service provider is seeking a Medical Claims Assessor in Selangor, Malaysia. The role involves accurately assessing medical claims, ensuring compliance with regulations, and providing exceptional customer service. Candidates should have relevant educational qualifications and experience in the insurance industry. Proficiency in English and Bahasa Malaysia, along with strong computer skills, is essential. This position offers the opportunity to work in a dynamic environment with additional tasks as needed.

Qualifications

• Must possess a diploma or higher in a relevant field.
• Experience in medical claims or insurance industry is an advantage.
• Able to work independently and manage customer interactions.

Responsibilities

• Assess and process medical claims within specified turnaround time.
• Review claims documentation for accuracy and completeness.
• Respond to inquiries regarding medical claims promptly.

Skills

Medical claims assessment

Fraud detection

Customer service

Communication in English

Communication in Bahasa Malaysia

Education

Diploma in Medical Science/Nursing/Pharmacy/Insurance

Bachelor’s Degree

Professional Certificate

Tools

Microsoft Word

Microsoft Excel

Job description

Job Purpose

The Medical Claims Assessor is responsible for the accurate and timely assessment of medical claims, ensuring compliance with policy terms and conditions. This role requires the ability to evaluate claims documentation, handle inquiries, investigate potential fraud, and provide high-quality customer service while adhering to company protocols and deadlines.

Key Responsibilities

Claims Assessment

Process and assess medical claims efficiently within the specified turnaround time, ensuring compliance with company policies, procedures, and insurance terms.

Review and verify claims documentation for accuracy and completeness, including medical reports, invoices, and receipts.

Collaborate with healthcare providers, clients, and internal teams to resolve any discrepancies in claims submissions.

Inquiries and Correspondence

Respond to inquiries related to medical claims, including feedback and complaints, promptly and professionally.

Maintain clear and consistent communication with clients, ensuring they are kept informed of their claims' progress.

Document Management

Ensure that all requests for supporting documents and additional information required for claim assessments are followed up on and obtained in a timely manner.

Maintain accurate records of claims, supporting documents, and communications in the claims management system.

Fraud Detection and Reporting

Investigate potential fraudulent claims, including irregularities in documentation or unusual patterns.

Report any suspicious activity or claims irregularities to the appropriate supervisory personnel for further investigation.

Compliance and Accuracy

Ensure that claims assessments adhere to internal and external regulatory guidelines.

Keep updated with the latest medical billing codes, insurance policies, and healthcare regulations.

Additional Duties

Perform ad hoc tasks and projects as assigned by supervisors or managers.

Assist with process improvement initiatives related to claims management and customer service.

Candidate must possess at least a Diploma, Advanced/Higher/Graduate Diploma, Bachelor’s Degree, Professional Certificate in Medical Science/Nursing/Pharmacy/Insurance or any related field.

Candidate with technical knowledge of medical claims or relevant working experience in Third Party Administration (TPA) / Insurance Industry will be an added advantage.

Good command in English & Bahasa Malaysia, both speaking and writing.

Able to work in fast paced environment, independent, customer focused and proactive working attitude with strong sense of responsibility.

Must be computer literate with knowledge of office applications such as Word, Excel, etc.

Flexible and willing to work extra hours as and when required.

Possess own transport.

This position will be based in I-City (5), Shah Alam

Candidates are required to apply online and only shortlisted for interview will be contacted.