Executive- Claims Analyst

IA International Assistance Sdn Bhd; Petaling Jaya; On-site; MYR 33,000 - 61,000; Full time

Job summary

IA International Assistance Sdn Bhd is seeking a Claims Analyst to perform medical insurance claims assessment in line with Health Insurance policies and guidelines. You will review billing information for accuracy and reasonableness, investigate claims, and liaise with relevant parties to determine liability of the insurer.

You will handle incoming and outgoing calls as part of standard procedures, work in shifts (24/7), and strive to meet KPIs while ensuring compliance with regulatory

Qualifications

• Diploma in Nursing or related Allied Health qualification is required.
• Fresh graduates are encouraged to apply as stated in the posting.
• Computer literate with good command of English and BM.

Responsibilities

• Assess medical billing for correctness and completeness.
• Review the reasonableness of tests, procedures, and hospital stays.
• Investigate claims and liaise with relevant parties to determine validity.
• Process all incoming requests within service standards and regulatory requirements.
• Handle 24/7 shift rotations and meet monthly/ yearly KPIs.

Skills

English

Bahasa Malaysia

Education

Diploma in Nursing or related Allied Health

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 24/7 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.

About IA International Assistance

IA International Assistance is aimed to become a major player in Contact Centre and Healthcare Third Party Administration (TPA) services that will combine back end processing through online Technology with comprehensive services for the industry.

We are an intermediary who connects insurance companies, corporates, policyholders and health care providers. The best way to describe us is, that we make our partners' work easier by providing them with end to end solutions.

The Mission

To provide the highest standard of service that adds value to our customers with an ultimate goal of becoming the preferred healthcare Contact Centre and TPA infrastructure provider in Malaysia with highest quality of services. Most of our professional team members have medical or pharmaceutical background and all of them are trained to give only the best services to our partners. We have always regarded the quality of its team members as most important asset, and its Human Resources Department (HRD) prepares the company's human resources to be employees who excel in attitude, knowledge, and skills relevant to the industry.

The Vision

To fulfill the customers goals of having the best services in thehealthcare and business process outsourcing for a better quality of life.

About IA International Assistance

IA International Assistance is aimed to become a major player in Contact Centre and Healthcare Third Party Administration (TPA) services that will combine back end processing through online Technology with comprehensive services for the industry.

We are an intermediary who connects insurance companies, corporates, policyholders and health care providers. The best way to describe us is, that we make our partners' work easier by providing them with end to end solutions.

The Mission

To provide the highest standard of service that adds value to our customers with an ultimate goal of becoming the preferred healthcare Contact Centre and TPA infrastructure provider in Malaysia with highest quality of services. Most of our professional team members have medical or pharmaceutical background and all of them are trained to give only the best services to our partners. We have always regarded the quality of its team members as most important asset, and its Human Resources Department (HRD) prepares the company's human resources to be employees who excel in attitude, knowledge, and skills relevant to the industry.

The Vision

To fulfill the customers goals of having the best services in thehealthcare and business process outsourcing for a better quality of life.

Your application will include the following questions:

• Which of the following statements best describes your right to work in Malaysia?
• Which of the following types of qualifications do you have?
• Which of the following languages are you fluent in?
• What's your expected monthly basic salary?
• Have you worked in a call centre before?
• How many years' experience do you have as a Claims Analyst?
• How would you rate your English language skills?
• How much notice are you required to give your current employer?