Registered Nurse – Medical Claim & Concierge Hotline

 MHC ASIA (HK) Limited

 Founded in 1994, Aim to connect doctors to the pool of corporates with technology — to drive greater transparency, governance and efficiency.
With close to 4,000 clinics in across Singapore, Malaysia and Hong Kong, ranging from GPs, Specialists, Dentists to TCMs, we connect your employees to accessible and affordable healthcare services.
MHC is not just a back-end administrator. Today, we have evolved to become a TPA ++ --- beyond third party administration and claims adjudication. Equipped with strong AI and analytical capabilities --- we run powerful algorithms to flag out, combat and contain escalating healthcare costs. This active surveillance program also enables us to detect fraudulent claim activities and identify trends early.
MHC Asia Group entering the Hong Kong Market with Jing King Tech Group in 2016 to simplify the managed care market that is both affordable and accessible for your workforce through MHC’s robust and unified platform.

 Job Summary
1. Handling pre-approval request, answering enquiries from members and service providers,
2. Providing health advice
3. Recruiting medical providers and monitoring its services standards
 
Roles and Responsibilities
Pre-approval & Hotline Operations
Process pre-approval requests in accordance with the terms and conditions of the policy and the authority level with 48 hours turnaround time

• Check eligibility of the member for benefit entitlement
• Issues Letter of Guarantee whenever required
• Approves Pre-approval with agreed fee and negotiates with the service providers’ to follow the logic of agreed fee
• Assist to claim team in specific claim adjudication. 
• Case management and approves Pre approval under the technical direction of company guideline.
• Handle Non-Network pre-approval duties whenever required
• Coordinate with Hotline service & service delivery (CS) team and Non-Network Pre-approval team to ensure smooth operation
• Provide training to Hotline service & Claim team

 
Hotline Duties

• Manage the Provider Pre-approval hotline and medical service concierge hotline to provide excellent customer services
• Responds to questions and problems from insured members and service providers regarding the interpretation and application of procedures concerning member care
• Reviews non-office hours hotlines call log and follow up Pre-approval process
• Provide Health advice
• Answer enquiries of medical services and LOG credit limit extension.

 
Healthcare initiatives and Panel network

• Review existing Pre-approval SOP and workflow as necessary in order to ensure consistency, accuracy of the output and excellent customer experience
• Review and improve system capabilities for efficient delivery of health services to clients and system interface with business partners
• Review system for enhancement for efficiency and convenience for customers
• Maintain & improve panel relationship to ensure accurate billing and prepare monthly performance report with reference to CMS report
• Assist Provider Management Team in initiating and maintaining network provider for health services including 1) establish working procedure and identify control process for compliance to ensure service standards and 2) accomplish the requirement for panel network on the submission of pre-approval request and EDI claims submission for accuracy and efficiency.

 
Other duties and responsibilities

• Being the Champion for staff engagement program
• Other duties and responsibilities as assigned by supervisor

 
Job Requirements

• University/College graduate in Nursing / Health Administration or relevant disciplines
• Registered nurse is required
• Knowledge of current care delivery system
• 2-3 years’ practical clinical & specialty experience
• Computer literacy
• Strong interpersonal, communication and analytical skills
• Good team player and customer focused
• Self-motivated, willing to take on challenges and able to work under pressure

We offer 5-days work and attractive remuneration package to the right candidates.  Interested candidates, please apply now.