Medical Claims, Team Lead

Hunters International Sdn Bhd; Petaling Jaya; On-site; MYR 150,000 - 200,000; Full time

Job summary

A leading claims management firm in Petaling Jaya is looking for a Case Management Specialist. The role involves advising on complex cases, managing medical claims services, and ensuring compliance with industry standards. Candidates should possess a relevant degree and strong communication skills in English and Bahasa Malaysia. A competitive remuneration of RM4,500 is offered.

Qualifications

• Degree in Science/Nursing/Medical bioscience or related field.
• Experience in Medical Claim services.
• Good spoken and written communication skills are necessary for daily contact with customers, providers and inter-offices.

Responsibilities

• Provide advice on cases exceeding Senior Officer authority.
• Authorize and determine insurers’ liability on claims.
• Ensure compliance with legal requirements and company policies.

Skills

Medical Claim services

Good communication skills

Proficiency in English and Bahasa Malaysia

Education

Degree in Science/Nursing/Medical bioscience or related field

Job description

Case Management, Client & Customer Services

• To provide advice, sound judgment and recommendation on case that surpasses the authority of a Senior Officer. Provide
  advice with appropriate referrals/ escalations as and when needed.
• To authorize, deny and determine extent of insurers liability on case of discharge that surpasses the authority of a Senior
  Officer.
• To ensure claims recommendations and decisions are complied with legal requirements, industry regulations, company policies and professional codes. To report to Manager of any claims fraudulent.
• To assist manager on establish strategies to manage the cost of health insurance. Ensure cost containment is practiced when adjudicating claims.
• Performing internal audit on claim assessment accuracy by recording errors notice in claim audit sheet.
• Prepare and analyze audit results, provide improvement suggestion to manager.
• Ensure no delay in the provision of services and cases to be closed in a timely manner within the agreed SLA.
• Execute SOPs, best practices, ISO policies and ensure compliance with policies. This shall include compliance of legislative requirement such as data protection and medical confidentiality.
• Ensure internal customer requests / inquiries for retrieval of claim documents are well attended on timely manner.
• Respond to clients enquiries via phone calls, e-mails and faxes within agreed client SLA, offering appropriate solutions and information.
• To cross- expose to any other areas/ team intra or inter department, to take up any other tasks as deemed fit or as assigned by the reporting supervisor when needed.

System, Infrastructure Maintenance & Risk Management

• To report faulty to manager and work closely with IT for the maintenance and upkeep of systems ensuring day- to- day
  operation runs smoothly without interruption.
• To be responsible for the readiness, reliability and stability of systems and systems related operating facilities.
• To involve in risk management, which includes analyzing, identifying, evaluating and estimating the risks which may affect the continuity of business.
• To work closely with Manager to execute and initiate Business Continuity Plans (BCP).

Job Requirements

• Degree in Science/Nursing/ Medical bioscience or related field.
• Experience in Medical Claim services.
• Good spoken and written communication skills are necessary for daily contact with customers, providers and inter-offices.
• Proficient in both spoken and written English, Bahasa Malaysia.

Remuneration

• RM4,500