Subject Matter Expert

2 days ago

Coimbatore, Tamil Nadu, India Cognizant Full time US$ 60,000 - US$ 80,000 per year

Role & responsibilities

    • Assist in validating and processing health insurance claims
    • Ensure accurate data entry and documentation of claim details in the claims management system.
    • Support the review of claims for completeness and compliance with policy terms and conditions.
    • Coordinate with internal departments to gather missing documentation or information.
    • Flag potential discrepancies or anomalies for further review.
    • Maintain confidentiality and data protection standards in handling sensitive health information.
    • Respond to basic inquiries from policyholders regarding claim status and documentation requirements.
    • Ensure timely processing of claims to meet service level agreements (SLAs).
    • Assist in generating reports for internal tracking and audit purposes.
    • Stay updated on changes in claims procedures and regulatory requirements in Hong Kong.
    • Support continuous improvement initiatives in claims processing workflows.
    • Participate in training sessions related to claims systems and regulatory updates.
  • Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines
  • Ability to communicate effectively across multiple channels, including phone, e-mail, chat, and text
  • Ability to succinctly collect information from a customer to set up a new claim
  • Ability to gather information from multiple source systems to understand and articulate the status of a claim and what information may be needed, next steps in processing, etc.

Preferred candidate profile

  • Bachelors degree in Life Sciences, Nursing, Healthcare Administration, or related field.
  • Basic understanding of medical terminology and health insurance products.
  • Proficiency in Microsoft Office and insurance processing systems.

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