JB-881

Job Title : Team Lead, Claims Operations - Cantonese

Job Category Type : Healthcare

Currency : Malaysian Ringgit(MYR)

Salary : MYR 9000

Country : Malaysia

State : Kuala Lumpur

Benefits : Annual Leave;Maternity leave;Paternity leave;Medical Insurance Outpatient & Inpatient;Sick leave;Hospitalization

Job Description :

The Medical Claim Supervisor oversees the medical claims team, ensuring efficient, accurate, and end to end compliant investigation. This leadership role involves managing team performance, implementing process improvements, and ensuing exceptional service delivery while aligning with Goals and Regulatory standards.

1. Leading and mentoring the Medical Claims team, setting performance goals, and monitoring KPIs.
2. Review and assess medical claims , ensuring alignment with policy guidelines and service standards.
3. Review and process complex claims cases and handle the case escalated by team members
4. Prepare and analyze the claims data and reports
5. Collaborate with HK Claims Team to conduct assessment and investigation if needed.
6. Provide guidance and support to facilitate junior advisors in service delivery and daily operations
7. Drive continuous improvement initiatives to optimize claims processing workflows
8. Providing the trend of suspicious case to suggest a FWA deduction framework
9. Updating the SOP and training note
10. Preform daily QC to ensure the team's accuracy

Requirements:

1. 1With 5 - 8 years experience in medical claims processing, including 2 years of supervisory experience
2. With healthcare background is preferred
3. With in-depth knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices
4. With depth knowledge on Fraud, Waste and Abuse (FWA), risk management or compliance frameworks
5. Strong analytical, presentation and problem-solving capability
6. Customer-oriented with excellent communication and interpersonal skills
7. Proficiency in claims management system, data analysis tools and AI

WFH Allowance :

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Housing Allowance :

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