Process Executive - Pre-Authorization - Health Insurance

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

Job summary

A leading company seeks a Process Executive - Pre-Authorization for Health Insurance, based in Kuala Lumpur. This role involves reviewing medical service requests, ensuring compliance with regulations, and effective communication with customers and providers. Ideal candidates will hold a relevant Bachelor's degree and have strong language skills in Cantonese, Mandarin, and English.

Qualifications

• Basic understanding of medical terminology and health insurance policies.
• Proficiency in Cantonese, Mandarin, and English (speak, read, write).
• Familiarity with Hong Kong's healthcare system and insurance regulations.

Responsibilities

• Review and validate pre-authorization requests for medical services.
• Ensure completeness of documentation submitted by policyholders and providers.
• Communicate authorization outcomes to providers and insured members.

Skills

Attention to detail

Communication

Data entry accuracy

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.