13 дней назад
Claims Representative, GEH APAC - Cigna Healthcare
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
Claims Representative (Medical Insurance): Processing and adjudicating medical insurance claims, pre-approvals, reimbursements, and recoupments in line with benefit policies and medical necessity, with an accent on accuracy, confidentiality, and service-level performance. Focus on assessing eligibility, resolving complex provider and payer queries, monitoring high-cost claims, and coordinating reconciliation with cross-functional teams.
Location: Kuala Lumpur, Malaysia
Company
Healthcare services organization supporting customers and providers through the health care system and medical insurance processes.
What you will do
- Process and adjudicate member and provider claims according to benefit policies, medical necessity, claim manuals, and standard operating procedures.
- Assess eligibility, maintain pre-approvals and authorization files, and provide accurate medical coverage information.
- Respond to provider and payer inquiries by phone and email, including complex queries requiring coordination with other teams.
- Monitor claims quality, productivity, turnaround times, service-level agreements, KPIs, and high-cost claims.
- Handle error adjustments, recoupment, reconciliation, and collection communications with providers and members.
- Maintain accurate system data, identify unclear claims, and suggest process improvements while protecting medical confidentiality.
Requirements
- At least 1–2 years of experience in a similar role; fresh graduates are also encouraged to apply.
- Graduate degree in medical or science-related studies.
- Claims processing or insurance experience is preferred but not essential.
- Awareness of medical terminology, strong administration and organizational skills, and proficiency in Microsoft Office applications.
- Strong written and verbal communication skills, with the ability to communicate across a diverse population.
- Ability to work independently and collaboratively, meet tight deadlines, and work shifts or staggered weekends for overtime.
Culture & Benefits
- Collaborative work with Finance, Customer Service, Eligibility, Network, Client Management, and other cross-functional teams.
- Structured performance expectations based on quality audits, service levels, productivity, responsiveness, and customer satisfaction.
- Opportunities to support colleagues, share knowledge, and assist with training.
- Work involves a fast-paced claims environment with defined procedures and operational targets.
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