Process Executive - Pre-Authorization - Health Insurance

Virginia Tech; Kuala Lumpur; On-site; MYR 150,000 - 200,000; Full time

Job summary

Une entreprise de premier plan, Virginia Tech, recherche un Process Executive pour gérer les pré-autorisations en matière d'assurance santé. Vous serez responsable de la validation des demandes de soins médicaux tout en assurant la conformité et la confidentialité des informations. Le candidat idéal aura un diplôme pertinent et une bonne maîtrise des trois langues : Cantonnais, Mandarien et Anglais, ainsi qu'une attention particulière aux détails et à la précision des données.

Qualifications

• Diplôme de premier cycle dans un domaine connexe.
• Connaissance de la terminologie médicale et des politiques d'assurance.
• Maîtrise du Cantonais, Mandarien et Anglais (oral et écrit).

Responsibilities

• Examiner et valider les demandes de pré-autorisation pour des services médicaux.
• Coordonner avec les équipes internes pour les cas complexes.
• Communiquer les résultats d'autorisation aux fournisseurs et aux membres assurés.

Skills

Communication efficace

Attention aux détails

Gestion des informations sensibles

Coordination

Education

Bachelor's degree in Nursing, Health Sciences, Insurance, or related field

Job description

Role: Process Executive - Pre-Authorization - Health Insurance

Location: KL, Malaysia

Experience: 0-4 Years

Job Responsibilities and Expectations:

• Review and validate pre-authorization requests for medical services and procedures.

• Ensure completeness of documentation submitted by policyholders and healthcare providers.

• Verify eligibility and coverage based on policy terms and conditions.

• Coordinate with internal claims and underwriting teams for complex cases.

• Input and update pre-authorization decisions in the claims management system.

• Communicate authorization outcomes to providers and insured members.

• Ensure compliance with Insurance Authority (IA) regulations and internal SOPs.

• Identify and escalate potential fraud or abuse cases to the compliance team.

• Maintain turnaround time (TAT) and service level agreements (SLAs).

• Support audits and quality checks by providing accurate documentation.

• Participate in training sessions to stay updated on regulatory changes.

• Handle sensitive medical information with strict confidentiality.

• Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines

• Ability to communicate effectively across multiple channels, including phone, e-mail, chat, and text

• Ability to succinctly collect information from a customer to set up a new claim

• Ability to gather information from multiple source systems to understand and articulate the claim - and what information may be needed, next steps in processing, etc.

Academic and Additional Qualifications Needed:

• Bachelor's degree in Nursing, Health Sciences, Insurance, or related field.

• Basic understanding of medical terminology and health insurance policies.

• Proficiency in Cantonese, Mandarin, and English (speak, read, and write).

• Familiarity with Hong Kong's healthcare system and insurance regulations.

• Strong attention to detail and data entry accuracy.

About Cognizant:

Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant.