Assistant Manager, Care Services

Job Description - Assistant Manager, Care Services (220001YP)

Job Number:

220001YP

Discover the GREAT in your career.

As a LIFE company, our customers are at the heart of all that we do. Being one of Asia’s leading insurers for over a century, we have built a long-lasting legacy of trust with our customers over many generations. At the foundation of this trust is Integrity, Initiative, and Involvement – from the way we treat every customer relationship with honesty and transparency, to our proactive approach of delivering the best possible solutions in both life and general insurance.

The Role:

• To adjudicate, review and process guarantee letter cases.
• Pre-certifies cases for issuance of guarantee letter in accordance with Company’s requirements and guidelines.
• Ensure initial and final guarantee letters are issued accurately and timely.
• Support Call Centre CSEs in handling technical/medical issues.
• Ensure cases of fee dispute are handled and resolved within targeted TAT.
• Back-up Call Centre operations.
• To attend to any other tasks assigned from time to time.
• To assist the Care Manager Handle/resolve issues and complaints related to guarantee letter issuance.
• To assist the Care Manager in handling of cases where medical necessity is questionable and decide on the course of action in consultation with medical officer.
• Takes accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks.
• Maintains awareness of industry trends on regulatory compliance, emerging threats and technologies in order to understand the risk and better safeguard the company.
• Highlights any potential concerns /risks and proactively shares best risk management practices.

The Person:

• Degree in Nursing or Healthcare related discipline of State Registered Nurse or Medical Assistant with 2-3 years of experience.
• 5 – 8 years of clinical experience preferably with experience in A&E, ICU and OT.
• Working experience in managed healthcare environment would be an asset.
• Good knowledge in current healthcare delivery systems and hospital patient management and billing system would be an advantage.
• Possess initiative, good interpersonal and communication skills.
• Knowledge in medical terminology, contract provisions and MMA coding.
• Good knowledge in current healthcare delivery systems and hospital patient management and billing system.
• Have the right attitude for hard work and able to produce high quality work under pressure.
• High level of integrity, takes accountability of work and good attitude over teamwork.
• Takes initiative to improve current state of things and adaptable to embrace new changes.

Great Eastern Malaysia is committed to Equal Employment Opportunity, and all qualified applicants shall receive a fair and equal consideration for employment.

Entity: Great Eastern Life Malaysia

Employment Type: Permanent