Deskripsi Pekerjaan
Are you a detail-oriented professional looking to advance your career in the healthcare insurance sector? Alliance Medinet is seeking a dynamic Claims Executive to join our expanding team in Johor Bahru. As a key player in our corporate managed healthcare business, you will be responsible for ensuring the accurate and efficient processing of medical claims, contributing directly to our mission of providing seamless healthcare administration services across the region.
At Alliance Medinet, we value precision, integrity, and proactive problem-solving. This role offers an excellent opportunity to work within a fast-paced corporate environment where your contributions have a tangible impact on service quality and client satisfaction. You will work closely with a team of healthcare professionals and administrators to navigate the complexities of medical billing and policy adherence. Our office in Johor Bahru provides a collaborative atmosphere where professional development is encouraged and excellence is recognized.
Joining Alliance Medinet means becoming part of a leading Third Party Administrator (TPA) that bridges the gap between healthcare providers and corporate clients. We leverage cutting-edge technology to streamline claims management, and you will be trained to use our internal systems effectively to maintain high standards of operational efficiency. If you are passionate about the healthcare industry and possess a keen eye for detail, we invite you to apply and grow your professional journey with us.
Tanggung Jawab
- Evaluate and process medical claims according to specific policy terms and corporate healthcare guidelines.
- Verify the authenticity and accuracy of medical bills and all necessary supporting documentation.
- Communicate professionally with healthcare providers, clinics, and corporate clients regarding claim status and any discrepancies found.
- Ensure all claims are adjudicated and settled within the established Service Level Agreements (SLAs).
- Identify potential fraudulent or irregular claims and escalate them for further investigation in a timely manner.
- Maintain comprehensive and accurate digital records within the internal claims management system.
- Assist in the generation of weekly and monthly claims data reports for management review and auditing purposes.
Kualifikasi
- Diploma or Bachelor’s Degree in Business Administration, Nursing, Insurance, or a related field.
- Minimum of 1-2 years of experience in claims processing, preferably within the healthcare or insurance industry.
- Fundamental understanding of medical terminology and standard billing procedures.
- Excellent command of English and Bahasa Malaysia, both written and spoken.
- Proficiency in Microsoft Office suite, particularly Excel for data tracking and Word for documentation.
- Proven ability to maintain high levels of integrity and attention to detail under pressure.
- Strong organizational skills with the ability to work independently and meet tight deadlines in a high-volume environment.