Sr. Specialist - AZAY Claim Hospital Fax

Job description

Claims Hospital Fax provide supports to team in handling fax claims received from hospitals, investigates and makes decision for claims in the system.  In addition, continuously monitors and makes decision for the pending cases of fax claims, or back log. 

1) Hospital Fax Claims
- Provide supports to team in handling the fax claims from the hospital
- Check the information from fax claims documents, and record into the system
- Investigate and make decision for claims in the system, by covering the below actions:
 Approve for the payment  base on authorization
 Perform rejection of fax claims received
 Require the additional information
 Issue memo into the system for administration in performing next steps
 Submit for further investigation
 Request the hospital records from hospital
- Continuously monitor and make decision for the pending cases of Claims Hospital Fax , or back log
- Consolidate the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization
2) Hospital assessment  Claims (OPD cahless)
- Provide support team in handling the  OPD cashless claims from the hospital
- Perform investigation and make decision for OPd cashless claims received in the system
§ Approve for the payment base on authorization
§ Perform rejection of fax claims received
§ Require the additional information
§ Issue memo into the system for administration in performing next steps
§ Submit for further investigation
§ Request the hospital records from hospital
- Continuously monitor and make decision for the pending cases of OPD cashless Claims Hospital , or back log
- Manage the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization

3) Report
- Collect the information, and support Manager - Claims Hospital Fax in providing the daily and monthly reports regarding to volume and turnaround time of Claims Hospital Fax

4) Support  
- Support Claim reimbursement 

Qualifications :

At least 3 yrs of experience in Claims assessor, or other related fields in insurance industry

Bachelor’s or Master’s Degree in Business Administration, Nursing, Business of Sciences (Medical Technology), or other related fiel

Any AI-future skills e.g., ChatGPT, or CoPilot 365, will be an advantage.