Job Location : Malaysia
Summary :
The Medical Claim Advisor handles appeal and more complex claims, provide guidance to junior advisors and new joiners to ensure high standards of accuracy and efficiency in claim processing. This role requires advanced knowledge of medical claims procedures and the ability to resolve escalated issues while maintaining compliance with regulations.
Roles & Responsibilities:
1. Review outpatient, day-care, and inpatient medical claims in accordance with policy terms, conditions, and Standard Operating Procedures (SOPs).
2. Analyze medical reports, discharge summaries, treatment records, invoices, and supporting documentation to determine claim eligibility.
3. Verify medical diagnoses, procedures, and treatment details using industry-recognized coding standards such as ICD-9, ICD-10, and CPT.
4. Categorize medical expenses under the appropriate benefit heads and accurately adjudicate claims based on policy coverage and available products.
5. Approve, reject, or adjust claims in line with policy exclusions, limits, and benefit entitlements.
6. Ensure completeness and accuracy of claim documentation and system updates.
7. Maintain productivity, quality, and turnaround time targets.
8. Support Advisors in resolving complex claim scenarios and policy interpretation queries.
9. Provide coaching, training, and knowledge-sharing sessions to improve team capability.
10. Identify unusual claim patterns, discrepancies, or potential Fraud, Waste, and Abuse (FWA) indicators and escalate appropriately.
11. Collaborate with HK Claims Team to conduct assessment and investigation if needed.
Experience:
1. With 1 - 5 years of experience in medical claims handling
2. With healthcare background is preferred
3. With in-depth knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices is preferred
4. Strong team player, willing to learn, able to work independently and effectively under pressure
5. Proficiency in claims management system
Language : Must be Proficient in Cantonese (Written & Verbal)
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.
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コグニザントについて
コグニザント（NASDAQ: CTSH）は、AI Builderおよびテクノロジーサービスプロバイダーとして、お客様にフルスタックのAIソリューションを構築することで、AI投資と企業価値を結ぶ架け橋となっています。業界、ビジネスプロセス、エンジニアリングに関する当社の深い専門知識を活かし、組織固有のビジネス環境をテクノロジー・システムに組み込みます。これにより、人間の可能性を最大限に引き出し、確かな成果を実現するとともに、急速に変化する世界においてグローバル企業が常に一歩先を行くための支援を行っています。 詳細については、cognizant.ai をご覧ください。
雇用に関する追加情報
本募集に記載されている報酬情報は、掲載日時点で正確なものです。Cognizantは、適用される法令に従い、いつでも本情報を変更する権利を留保します。
応募者は、対面またはビデオ会議による面接への参加を求められる場合があります。また、各面接の際に、現在有効な州政府または政府発行の身分証明書の提示を求められる場合があります。
Cognizantは機会均等雇用主です。応募および選考において、人種、肌の色、性別、宗教、信条、性的指向、性自認、国籍、障がい、遺伝情報、妊娠、退役軍人の地位、その他連邦法・州法・地方自治体の法律により保護されるいかなる特性に基づく差別も行いません。
