ProtechHealth: Executive / Senior Executive Claims

Senior Executive / Executive Claims

Role Description

The Claims Executive is responsible for supporting and coordinating claims management and operations activities.

Responsibilities

1- Support the day-to-day operations of the Operations Department to achieve set Turn-around-Time for all defined processes whilst ensuring the quality of claim processing, e.g. registration, provision, adjudication, approval, and settlement.

2- Assist to develop comprehensive medical care and health care business claims rules.

3- Assist in developing, documenting, and updating policies, procedures, and workflow of the department.

4- Provide accurate, reliable, and timely financial and statistical reporting of operations including claims, recovery, receivables, and provisions.

5- Liaise with Customer Relationship Management and other related departments on customer complaints and other programs designed to delight customers.

6- Conduct analysis, and prepare periodic reports and presentations when required.

7- Resolves medical & non-medical claims by approving or denying documentation, calculating benefits due, initiating payment, and/or composing a denial letter

8- Any other tasks that may be assigned from time to time related to claims management roles and functions.

Requirements

1- A Bachelor’s degree preferably in medical, pharmacy, biotech, or any health-related field.

2- Working experience in SPIKPA / Medical or Healthcare Sector will be an added advantage.

3- Preferably experience involves in system enhancement and product development.

4- Excellent written and verbal communication skills.

5- Computer literate and proficient in Microsoft Office. Candidates must be willing to learn new computer systems and skills as necessary.

6- Willingness to work creatively and collaboratively in an interdisciplinary environment

7- Organised and self-motivated

8- Ability to manage multiple tasks and meet the demands of a fast-paced environment with changing priorities.

9- Preferably Takaful background candidates

Email to: career@protecthealth.com.my

(Source: Nur Afiqah Jamal, 2022)