Subject Matter Expert
4 days ago
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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