Executive - Claim Analyst, Contact Centre

IA International Assistance; Petaling Jaya; On-site; MYR 39,000 - 61,000; Full time

Job summary

IA International Assistance in Malaysia is seeking a Claims Analyst to assess medical insurance claims in accordance with Health Insurance guidelines, rules, and benefits. You will investigate claims, determine liability, and ensure timely, accurate payments while coordinating with relevant parties.

The role requires a Diploma in Nursing or related allied health field; fresh graduates welcome. English and Bahasa Malaysia proficiency, computer literacy, and the ability to work on a 24/7 shift

Qualifications

• Minimum Diploma in Nursing or any Medical Related Allied Health qualification.
• Fresh graduates are encouraged to apply.
• Working experience in Healthcare, Insurance, TPA, or related fields is an advantage.
• Must be computer literate with good command of English and Bahasa Malaysia.
• Malaysian citizens or valid residence status.

Responsibilities

• Perform medical insurance claims assessment according to Health Insurance guidelines, rules and benefits.
• Assess legal implications and protect our client’s interest.
• Ensure claims are paid timely and accurately.
• Investigate claims by liaising with relevant parties to determine validity and liability.
• Manage daily operations to meet productivity and service standards.
• Process all incoming requests within service standards and comply with regulatory and corporate requirements.
• Review billing information for correctness and reasonableness of tests, procedures and hospital stays.
• Refer to medical claims for further investigation when necessary.
• Identify inaccuracies in incurred claims and coordinate resolution.
• Handle incoming/outgoing calls as per claims experience procedures.
• Be able to work on a 24/7 rotation schedule and meet KPIs.

Skills

Computer literacy

English language

Bahasa Malaysia

Team player

Stress management

Shift flexibility

Education

Diploma in Nursing or Medical Allied Health

Medical degree advantageous

Job description

• To perform medical insurance claims assessment according to the Health Insurance and Medical guidelines, rules, and regulations of the Health Insurance Policy, Plan, and Benefits.
• To assess the legal implications, and potential risks and protect our client’s interest.
• To ensure that all claims are paid in a timely and accurate manner.
• To investigate claims through liaison with relevant parties to determine the validity of the claims and liability of the insurer.
• Accountable on daily operations in order to meet or exceed productivity or service standards as defined by Management in line with department or team goals.
• Process all incoming requests within the service standard and ensure all processes are done prudently and in accordance with all regulatory and corporate requirements.
• The claims analysts will review billing information for correctness and completeness. The analyst reviews medical billings for the reasonableness of tests, procedures, and hospital stays.
• The analyst refers to medical claims for further investigation when more information is necessary or when claims are not medically reasonable. Medical claims may require additional documentation or investigation before the payment guarantee is confirmed.
• Analysts review incurred claims to ensure accuracy. The analyst identifies inaccuracies of incurred claims and works with the necessary party to resolve claims incurred in error.
• Responsible for all incoming and outgoing calls as a procedure for each claims experience
• Manage time and be able to work on shifts, guided by the team managers on a 24/7 service level deliverables
• Meet company KPIs on a monthly and yearly basis where applicable.
• Minimum Diploma in Nursing or any other Medical Related Allied Health qualification.
• Candidates with Medical Degrees will be an added advantage.
• Working experience in Healthcare, Insurance, TPA, or related fields will be an advantage.
• Must be computer literate and have a good command of English and Bahasa Malaysia. Literacy in other languages would be an advantage.
• Have a good foundation in delivering quality service to customers.
• Knowledge of medical terminologies especially Disease and Treatment will be an advantage.
• High motivation and must be a strong team player, able to manage stress management and willing to work flexible hours.
• Applicants should be Malaysian citizens or hold relevant residence status.
• Able to work on 24/24 rotation schedule (AM,PM,ON)
• Candidate/s with Call Centre/Contact/Service Desk center experience will be an advantage.
• Fresh graduates are encouraged to apply.