Claims & Call Centre Executive: Customer Solutions Pro

CompuMed Services Sdn Bhd; Kuala Lumpur; On-site; MYR 33,000 - 60,000; Full time

Job summary

CompuMed Services Sdn Bhd is recruiting for a Claims Executive or Assistant / Call Centre Executive to deliver quality customer service on medical/insurance claims and clinical services issues. The role involves liaising with hospital staff, preparing documents for claim submissions, and adjudicating claims while ensuring timely submission and accurate reporting.

The candidate should have at least STPM/A Level/Pre-U/Diploma/Degree or equivalent, with experience in medical/ life insurance claims

Qualifications

• 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 its application is an added advantage
• Good spoken and written communication skills in Bahasa Malaysia & English
• Communication and interpersonal skills.
• Computer Literate
• Working experience in TPA, insurance or healthcare industry

Responsibilities

• 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 & Claims team and support to the new recruits in the Company.
• Subject to the shifts and abiding to the duty roster prepared by the Management.
• Approval of simple claims during and after office hours.
• Prepare Payment Notice, GL & DL, Admission, Billing in daily course of duties.
• 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.
• Perform relief task as and when required by the Management.
• Maintain a proper filing system.

Skills

Communication skills

Bahasa Malaysia

English

Interpersonal skills

Computer literacy

Insurance terminology

Education

STPM/A Level/Pre-U/Diploma/Degree or equivalent

Job description

CompuMed Services Sdn Bhd is recruiting for a Claims Executive or Assistant / Call Centre Executive to deliver quality customer service on medical/insurance claims and clinical services issues. The role involves liaising with hospital staff, preparing documents for claim submissions, and adjudicating claims while ensuring timely submission and accurate reporting.

The candidate should have at least STPM/A Level/Pre-U/Diploma/Degree or equivalent, with experience in medical/ life insurance claims