Executive, Claims
2 weeks ago
Assist in the review of Pre-admission / 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 Pre-admission / Letter of Guarantee (LOG) cases.
- Ensure accurate review of Pre-admission / Letter of Guarantee (LOG) cases in a timely manner.
- 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 multi-task - 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 Pre-admission/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 Pre-admission/In-Patient related issue
- Provide advice and information on insurance contract and medical knowledge
- Other ad hoc duties and responsibilities as assigned by Superior
- Diploma/Degree holder
- Minimum a year working experience in health claims department or healthcare industry.
- Proficient in MS office
- Customer service skill
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