Job Title: Processor (Claims Operations)
Location: Malaysia
Job Responsibilities And Expectations
- Process health insurance claims in accordance with Hong Kong's Insurance Authority (IA) regulations.
- Verify policyholder eligibility and coverage details before claim adjudication.
- Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines
- Ability to communicate effectively across multiple channels, including phone, e-mail, chat, and text
- Ability to succinctly collect information from a customer to set up a new claim
- Ability to gather information from multiple source systems to understand and articulate the status of a claim - and what information may be needed, next steps in processing, etc.
- Ensure accurate data entry and documentation of claim details in the system.
- Coordinate with healthcare providers to validate treatment and billing information.
- Identify and escalate potential fraud or abuse cases to the compliance team.
- Maintain turnaround time (TAT) and service level agreements (SLAs) for claims processing.
- Respond to internal queries related to claim status and documentation.
- Ensure compliance with internal SOPs and regulatory standards.
- Support audits by providing required documentation and clarifications.
- Participate in training sessions on regulatory updates and system enhancements.
- Maintain confidentiality and data privacy in handling sensitive health information.
- Collaborate with customer service teams to resolve member inquiries.
Academic and Additional Qualifications Needed
- Bachelor's degree in Insurance, Healthcare Administration, or related field.
- 1-5 years of experience in health insurance claims processing.
- Basic understanding of Hong Kong's health insurance regulatory framework.
- Proficiency in claims processing systems and MS Office tools.
- Fluency in Mandarin, Cantonese, and English (speak, read, and write).
About Cognizant:
Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant .
