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Manager (Claims / Pre-authorisation)
2 weeks ago
Working location:
Bendemeer
- Supervise and manage a team of assessors for Preadmission Assessment / Letter of Guarantee (LOG) issuance and ensuring that all key deliverables are met.
- Assist in the review of Preadmission / Letter of Guarantee (LOG) cases in accordance to clients' requirements and policy.
- Act as the liaison person for both the service providers and clients in the review of Preadmission / Letter of Guarantee (LOG) cases.
- Ensure accurate review of Preadmission / Letter of Guarantee (LOG) cases in a timely manner.
Key accountabilities:
- Supervise and manage a team of assessors for Preadmission Assessment / Letter of Guarantee (LOG) issuance and ensuring that all key deliverables are met.
- Works with internal departments including Key Accounts Managers, Benefits Teams, Channel Relations Management &/or Medical Team.
- Reconcile outstanding pending case requirements and requests for additional information with Clinics/Doctors/Business Office.
- Have a sense of urgency without losing attention to detail, and the ability to multitask
- Ensure Pre Admission &/or LOG process within turnaround time.
- Assessing and review case within authority.
- Making appeal on behalf of clinics to Approvers.
- Handling urgent request from Partners, Benefits Teams and Account Manager.
- Ensure Preadmission/In-Patient claims assessment align with Partners' contract and practice.
- Contact hospital/clinic for bills breakdown and clarification.
- Handle Letter of Guarantee (LOG) request.
- Reviewing LOG request and approving issuance of LOG within authority.
- Reviewing and assisting with supersede LOG request
- Answering and handling enquires from account manager on Preadmission/In-Patient related issue
- Provide advice and information on insurance contract and medical knowledge
- Other ad hoc duties and responsibilities as assigned by Superior
Qualifications & Experience:
- Diploma/Degree holder
- Minimum 3 years working experience in health claims department or healthcare industry.
- Proficient in MS office
- Customer service skill
Additional Information:
- Meticulous with keen attention to details
- Articulate and confident
- Resourceful
- Team player
- Independent
- Able to multitask
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