Senior Outpatient Claims Specialist

DOCTOR ANYWHERE OPERATIONS PTE. LTD.; Petaling Jaya; On-site; MYR 42,000 - 66,000; Full time

Job summary

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

Qualifications

• 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.

Responsibilities

• 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

Skills

Self-motivated

Problem-solving

Team player

Service-oriented

Ownership

Ambiguity tolerance

Education

Diploma/Degree in any discipline

Health Insurance certification (preferred)

Job description

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