Claim Assessor

Company Description

MediExpress, part of Sumitomo Corporation Group, is a leading Third-Party Administrator specializing in managing employee medical benefits and claims for insurers and corporate clients. Based in Kuala Lumpur and operating since 1998, MediExpress serves a diverse clientele of businesses, government bodies, and insurers with a dedicated 24/7 team of over 300 employees. By integrating technology and medical expertise, MediExpress emphasizes preventive care and provides convenient services such as telemedicine and e-pharmacy, improving access to healthcare. Our data analytics tools offer actionable insights into medical trends, enabling organizations to make informed decisions, while maintaining cost-effective health management strategies.

Role Description

We are seeking a detail-oriented and proactive Claim Processor Cashless Admission to join our health insurance operations team. The ideal candidate will be responsible for verifying, authorizing, and processing cashless hospitalization claims in compliance with company policies and regulatory guidelines. This role requires strong analytical skills, medical knowledge, and the ability to coordinate effectively with hospitals, internal teams, and customers.

Key Responsibilities

• Review and process cashless hospitalization requests received from network hospitals.
• Validate policy coverage, eligibility, and pre-authorization documentation.
• Coordinate with medical officers and hospital representatives to obtain necessary clarifications.
• Ensure timely approval or rejection of claims as per company SLAs and regulatory standards.
• Communicate claim decisions clearly and professionally to all stakeholders.
• Identify potential fraud or discrepancies and escalate as required.
• Collaborate with internal audit and quality teams for continuous process improvement.

Qualifications and Skills

• Bachelor's degree or Diploma in any discipline (preferably Life Sciences, Nursing, or Healthcare Management).
• 13 years of experience in health insurance claims processing or TPA operations.
• Strong understanding of medical terminology and hospital billing procedures.
• Proficiency in MS Office and claims management systems.
• Excellent communication and coordination skills.
• Attention to detail and ability to work under pressure.

Work Schedule

• Shift-based working hours (rotational shifts including day, evening, and night).
• Flexibility to work weekends or public holidays as per operational requirements.
• Additional allowances or benefits may apply for shifts.