Job Responsibilities

• Handle pre-approval of commercial assessment
• Handle claims process, including both inpatient and outpatient medical claim
• Communicate with customer on pre-approval decision
• Improve the effectiveness of the claim adjudication and administration processes, with network service providers when necessary
• Handle provider claim enquiries from panel network
• Prepare report to management
• Conduct claim assessment processes, claim investigation and to review all status and ensure efficient outcome in customer oriented approach
• Meet standard of individual quality, turnaround time and productivity benchmark.
• Handle project tasks and arrangement

Requirements

• Diploma or above, preferably with insurance-related qualifications, e.g. FLMI, ICA
• At least 3 years’ experience in claims adjudication / administration
• Experience in working with pre-approval of medical claims
• Good team player, able to work independently and under pressure in a fast-paced environment
• Possess customer centricity mindset
• Good interpersonal and communication skills
• Cantonese speaker with good command of both English and Chinese
• Candidate without Claims experience but with a medical-related degree will also be considered.