- Process pre-authorisation and pre-assessment cases according to the policies and guidelines;
- Process clinical operation and day case claims based on delegated claims authority in accordance with the established procedures and guidelines;
- Handle enquiries and complaints from both external and internal parties;
- Identify and investigate suspicious / fraudulent claims, and escalate cases to supervisor(s) where appropriate;
- Assist in system enhancement and workflow adjustment to meet customers' needs and service standard;
- Handle ad-hoc duties as assigned by supervisor(s).
- Diploma holder or above in any disciplines with minimum 5 years of relevant experience in medical claims, customer services or complaint management
- Professional qualification in FLMI, FLHC, etc. will be an advantage
- Familiar with operation of medical claims and healthcare network providers
- Good communication and interpersonal skills
- Detail-minded with strong sense of responsibilities and well-organized
- Flexible and customer-oriented
- Able to handle multi-task and work under pressure in a fast paced environment
- Good command of both written and spoken English and Chinese
- Proficient in MS Office and Chinese Word Processing
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Medical Service, Specialist - Hong Kong, 香港 - AIA
描述
FIND YOUR 'BETTER' AT Blue Cross
If you believe in better, we'd love to hear from you.
About the Role
Responsible for handling and approving medical claims based on delegated claims authority in accordance with the established procedures and guidelinesAccountabilities:
Requirements:
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