Medical Claims Processor

Working Arrangement:

Hybrid

Job Description:

Key Responsibilities:

• Process and capture information to system according to established methods and procedures
• Handles inpatient claims worldwide (mainly from Hong Kong, Macau and Mainland China)
• Issues decline / follow-up  to the clients for outstanding information and clarifications
• Practice good judgment in approving, make necessary recommendation and declining medical claims of clients
• Consistently attain the service level set by the Company
• Assist colleagues and other teams in their production work upon request
• Setup cases and identify discrepancies and irregularities during processing
• Suggest ways on how to improve the current process and team metrics
• Handle multiple tasks in a fast-paced environment
• Constantly increase the number of knowledgeable functions handled by the team
• Such other duties and functions as assigned by Supervisor

Qualifications:

•    Medical knowledge
•    1-2 years Medical claims experience
•    Knowledge in claims processing
•    Completed a Bachelor’s Degree in related field

Technical Skills:

•    Minimum keyboard typing skills of 32 words per minute
•    Ability to use desktop computer system
•    Lotus Notes knowledge 
•    Knowledge of MS Applications (Word, Excel & MS Power point)

Soft Skills:

•    Chinese literate including reading comprehension and typing (this is already indicated and will be verified in minimum qualifications)
•    Good written and verbal communication skills  (English & Chinese)
•    Ability to express ideas clearly and concisely in writing letters to clients and agents

Required key attributes: 

•    Good organization and analytical skills
•    Willing to render overtime work as needed
•    Flexible and adaptable to change
•    Proven ability to balance approach in different levels of transactions
•    Willingness to experiment and take risks
•    Can handle multiple tasks in a fast-paced environment
•    Proficient in handling all the work and processes assigned
•    Always on time to work / meetings and is not sickly
•    Accountable for one's actions                                                                  
•    Compliance-minded 
•    Demonstrates initiative to improve
•    Open for team collaboration
•    Extra-miler and constantly pushes the limits of current responsibilities            
•    Has a positive attitude towards accepting additional challenges and new assignments                     
•    Customer-centric and service oriented 
•    Actively pursues personal and professional development opportunities
•    Fast learner 

Process Specific Knowledge: 

•    Knowledge of evaluating application forms, claim history, inforce period, attending physician statement with the ability to making sound assessment
•    Ability to understand the logic of pre existing conditions, non disclosures & exclusions within every claim assessed
•    Be able to provide sound decisions whether to proceed investigation/s, decline, approve or to re-route to underwriting the claim cases handled