[MY] Senior/Executive, Outpatient Claims (1 Year Contract)

DOCTOR ANYWHERE OPERATIONS PTE. LTD.; Petaling Jaya; In loco; MYR 42.000 - 66.000; Tempo pieno

Descrizione del lavoro

Doctor Anywhere's Operations team seeks an Outpatient Claims Executive to provide accurate adjudication of health insurance claims submitted by our clients. The ideal candidate will embrace continuous improvement and navigate ambiguity in a startup environment.

This role reports directly to the Team Lead, Outpatient Claims. Key responsibilities include proactive claims management, adjudication within authority limits, timely responses to queries, and building strong relationships with clients

Competenze

• Diploma/Degree in any discipline with minimally 3 years of assessing claims in Insurance/ Medical Assistance/ TPA experience.
• Open to a 1 year contract position.
• Health Insurance certification preferred but not mandatory.

Mansioni

• Proactive management of claims, timely processing & claim administration within stipulated turnaround time (TAT).
• Adjudicate outpatient claims and decide on claim settlements and approve within authority limit.
• Ensure all queries are responded to in a timely manner with continuous communication with both internal and external customers and providing the required support with the objective of providing a quality claim service experience.
• Work and maintain positive relationship with customers / corporate clients for any claims related matters
• Assist to provide necessary information and ad-hoc assignment to Manager to allow for accurate and timely submission of reports to management as well as maintaining the records, reports and claims file
• Investigate and elevate technical claim issue as and when experienced
• Other ad-hoc duties as assigned

Conoscenze

Self-motivated

Problem-solving

Team player

Service-oriented

Ownership

Ambiguity tolerance

Formazione

Diploma/Degree in any discipline

Health Insurance certification (preferred)

Descrizione del lavoro

Doctor Anywhere's Operations team plays a vital role in driving the success of our TPA business. Our scope includes end-to-end claims processing, Letter of Guarantee (LOG) issuance, customer service, business processing, and panel network management. We support both virtual and in-person clinical services, ensuring smooth daily operations and swift resolution of any issues. Our focus is on delivering operational excellence and consistently providing a best-in-class customer experience keeping our customers at the heart of everything we do.

About the role

We are seeking an Outpatient Claims Executive who will provide accurate adjudication of Health insurance claims submitted by our clients. The ideal candidate will have a mindset of continuous improvement and change and will demonstrate curiosity, collaboration and the ability to deal with ambiguity especially in a start-up environment.

This role reports directly to the Team Lead, Outpatient Claims.

A summary of the key responsibilities are as follows:

• Proactive management of claims, timely processing & claim administration within stipulated turnaround time (TAT)
• Adjudicate outpatient claims and decide on claim settlements and approve within authority limit
• Ensure all queries are responded to in a timely manner with continuous communication with both internal and external customers and providing the required support with the objective of providing a quality claim service experience.
• Work and maintain positive relationship with customers / corporate clients for any claims related matters
• Assist to provide necessary information and ad-hoc assignment to Manager to allow for accurate and timely submission of reports to management as well as maintaining the records, reports and claims file
• Investigate and elevate technical claim issue as and when experienced
• Other ad-hoc duties as assigned

About you

• Diploma/Degree in any discipline with minimally 3 years of assessing claims in Insurance/ Medical Assistance/ TPA experience.
• Open to a 1 year contract position
• CGI and Health Insurance certification preferred but not mandatory
• Self-motivated individual with a strong sense of responsibility
• Resourceful with strong problem-solving skill
• Good team player and service-oriented
• A start-up attitude - you take full ownership of things that you do and are willing to go out of your comfort zone and take on new challenges and changes within the organization.
• Comfortable with ambiguity and flexible to learn new things - we’re not done growing and heading into uncharted territories is part of the fun!

About Doctor Anywhere

Doctor Anywhere (DA) is a regional tech-enabled, omnichannel healthcare provider delivering care to 2.5 million users across 6 countries in Southeast Asia. Founded in 2017 with a mission to make healthcare simple, accessible, and efficient for all, DA leverages technology to enable individuals towards preventive, long-term health via holistic offerings including our telehealth app, physical clinics and pharmacies, mental wellness, specialist consults, and also an online health & wellness marketplace for supplements, healthy snacks, home-based health screening and vaccinations.

DA’s goal is to build a regional digital healthcare ecosystem, advanced by the 3,000 GPs and specialists within our regional network, over 1,000 corporate organisations, and 25 regional insurers we work with. Grounded in our motto “Keep Going, Keep Growing”, our team strives towards excellence, with innovation and collaboration at our core, and values diversity in perspectives brought by every member. Join us in our mission to transform Southeast Asia’s healthcare future!