EXECUTIVE, CASE REVIEW

KPJ Bandar Maharani Specialist Hospital; Muar; On-site; MYR 45,000 - 78,000; Full time

Job summary

KPJ Bandar Maharani Specialist Hospital in Malaysia seeks an Insurance and Billing Officer to review admission documents, medical reports, and insurance coverage, liaising with consultants and clinical teams to ensure accurate documentation for claims.

You will coordinate pre-authorizations, monitor billing accuracy in the hospital system, and support the Business Office and Finance Department to submit timely claims.

Qualifications

• Diploma or Bachelor in Business Administration, Accounting, Finance or equivalent.
• 2-3 years in healthcare billing, case review, or insurance claims.
• Familiar with hospital systems (KCIS/HITS).
• Understanding of insurance processes and hospital billing procedures.

Responsibilities

• Review and verify admission documents, medical reports, and insurance coverage.
• Coordinate with consultants and clinical teams to ensure proper documentation for claims.
• Obtain pre-authorization, guarantee letters, and approvals from insurance companies.
• Ensure accuracy of charges and billing data before submission.
• Monitor patient length of stay and treatment plans to avoid claim rejections.
• Prepare reports on case status, approvals, and rejections for management.
• Support the Business Office and Finance Department in timely claim submissions.
• Escalate complex cases to Accountant/Lead, Business Operations.

Skills

Analytical skills

Communication

MS Office

Education

Diploma/Bachelor in Business/Finance

Healthcare/medical billing knowledge

Tools

KCIS/HITS

Job description

Job Description

Review and verify patient admission documents, medical reports, and insurance coverage. Liaise with consultants, doctors, and clinical teams to ensure proper medical documentation is available for insurance claims. Coordinate with insurance companies for pre-authorization, guarantee letters, and claims approvals. Ensure accuracy of charges and billing information in the hospital system before submission. Monitor patient length of stay, treatment plans, and approval validity to avoid claim rejections. Assist in resolving insurance queries, disputes, and billing discrepancies. Prepare and submit required reports to management regarding case status, approvals, and rejections. Support the Business Office and Finance Department in ensuring timely and accurate claim submissions. Provide guidance and support to patients and families on insurance coverage and claim procedures. Maintain compliance with hospital policies, insurance guidelines, and regulatory standards. Escalate complex cases to the Accountant/Lead, Business Operations for further action. Ensure confidentiality of patient medical and financial information at all times.

Education

• Minimum Diploma in Business Administration, Accounting, Finance, or equivalent
• Bachelor of Business Administration, Accounting, Finance, or equivalent

Knowledge and experiences

At least 2–3 years of working experience in healthcare billing, case review, insurance claims, or related fields. Familiar with hospital systems (KCIS/HITS). Good understanding of insurance processes, corporate client agreements, and hospital billing procedures. Experience in handling audits, case verification, and reporting.

Skills and competency

• Strong analytical and problem-solving skills in case verification and billing.
• Excellent communication and interpersonal skills for liaising with doctors, nurses, patients, and insurance providers.
• Competent in Microsoft Office (Excel, Word, PowerPoint).

Special skills are required

• Knowledge of medical terminology and coding for billing verification.
• Ability to interpret insurance coverage and entitlements accurately.
• Attention to detail to minimize errors in billing and claims.
• Skilled in preparing accurate reports and presenting findings to management.

Personal attributes

• High level of integrity, confidentiality, and professionalism.
• Proactive, meticulous, and detail-oriented.
• Strong sense of accountability and responsibility.
• Team player with leadership potential to guide Case Review Assistants.
• Positive attitude with commitment to continuous learning and improvement.

KPJ Healthcare Berhad

KPJ Healthcare Berhad is founded on the vision of being the preferred healthcare provider in the region. We are focused on delivering world‑class quality healthcare services throughout our regional footprint across 5 countries, namely Malaysia, Indonesia, Thailand, Bangladesh, and Australia. We are in search of remarkable people to join us in exploring and discovering better healthcare solutions together. Whether you are a student, a graduate, or an experienced professional, discover the impact you could make with a career at KPJ.