Healthcare Executive, LOG (Letter of Guarantee)

HMI Managed Healthcare; Kuala Lumpur; On-site; MYR 40,000 - 60,000; Full time

Job summary

A healthcare management company in Kuala Lumpur is seeking a Healthcare Executive to manage claim pre-authorizations and ensure operational excellence. Responsibilities include adjudication of cases, early investigations, and negotiations with network providers. Ideal candidates should have a minimum diploma with two years of experience in health claims or medical insurance, along with excellent communication skills. This role also welcomes candidates from nursing backgrounds looking for a career change.

Qualifications

• At least 2 years of health claims and/or medical insurance experience.
• Relevant Insurance Certificate (e.g., Cert SCI in Health Insurance) is a plus.
• Nursing background candidates are welcome for career switch.

Responsibilities

• Handle pre-authorization of applications and issuance of Letters of Guarantee.
• Provide accurate and timely adjudication of cases to meet operational targets.
• Manage early claim investigations and complex claims.

Skills

Analytical skills

Communication skills

Customer-centric approach

Ability to work under pressure

Team player

Education

Minimum Diploma

Job description

Healthcare Executive, LOG (Letter of Guarantee)

You will be handling pre-authorization of applications and LOG issuance under the healthcare plans.

Provide accurate and timely adjudication of cases within the required service standards to meet operational and SLA targets

Handle early claim investigation, complex claims and appeals.

Willing to negotiate with network provider on the cost-effective options for stakeholders.

Management of cases including liaison with providers and insurers.

Job Requirements

• Minimum Diploma with at least 2 years of health claims and/or medical insurance experience;
• Relevant Insurance Certificate e.g. Cert SCI (Health Insurance) will be an added advantage;
• Candidates with nursing background looking for a career switch or new challenges will also be seriously considered;
• Strong, analytical, written and communication skills;
• Customer-centric and meticulous with the ability to work under pressure; and team player