CLAIMS EXECUTIVE / ASSISTANT

CompuMed Services Sdn Bhd; Kuala Lumpur; On-site; MYR 39,000 - 61,000; Full time

Job summary

CompuMed Services Sdn Bhd is seeking an Executive Assistant to adjudicate admission and outpatient claims, and to compile supporting documents for submission to clients. You will ensure timely submission and monitor claim settlement timelines in a fast-paced healthcare BPO environment.

The role requires knowledge of medical/insurance terminology, strong communication in BM and English, and experience in healthcare or insurance.

Qualifications

• At least STPM/ A Level/ Pre-U /Diploma/Degree or equivalent.
• Experience in medical/health insurance claims.
• Knowledge of medical terminologies and insurance policies.
• Working experience in healthcare or insurance.

Responsibilities

• Adjudicate claims for admission, outpatient and major claims.
• Compile supporting documents with each claim submission.
• Ensure timely submission of claims and monitor settlement timeline.
• Provide polite, professional responses per service standards.
• Liaise with hospital personnel for member management during hospitalization.
• Maintain proper filing system.

Skills

Communication skills

Bilingual English-Bahasa

Computer literacy

Healthcare/insurance knowledge

Education

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

Tools

MS Office

Job description

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

Unlock job insights

Hirer responsiveness Salary match Number of applicants

We are an established business process outsourcing (BPO) provider specializing in individual and corporate employee healthcare benefit administration and management services. We seek to recruit service-oriented individuals to deliver excellent customer service and innovative solutions to our clients.

Our Vision

- To see Malaysia develop into a participative health caring culture where every citizen contributes, cares for each other and is assured of a universal health benefits for life.

Our Mission

- To contribute towards and promote participative health caring culture in Malaysia by offering the best healthcare demand and supply chain management services and setting benchmark for healthcare customer servicing.

What can I earn as an Executive Assistant