JB-879
Job Title : Advisor, Claims Operations - Cantonese
Job Category Type : Healthcare
Currency : Malaysian Ringgit(MYR)
Salary : MYR 4600
Country : Malaysia
State : Kuala Lumpur
Benefits : Annual Leave;Maternity leave;Paternity leave;Medical Insurance Outpatient & Inpatient;Sick leave;Hospitalization
Job Description :
The Medical Claim Advisor is responsible for daily claim processing and evaluating medical insurance claims to ensure accuracy, compliance, and timely resolution. The role involves reviewing documentation, verifying coverage and communicating with their senior to facilitate smooth claim processing
- Assess medical claims in compliance with the terms and conditions of the policy
- Verify medical codes, diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9, ICD 10, CPT)
- Escalate enquiries and complex cases to Senior when necessary in line with internal guidelines
- Process claims payment in accordance with the company's objectives and guideline
- Prepare claim communication letter
Requirements:
- With 1 - 3 years of experience in medical claims handling
- With healthcare background is preferred
- With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices is preferred
- Strong team player, willing to learn, able to work independently and effectively under pressure
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