Role: Process Executive - Pre-Authorization - Health Insurance
Location: KL, Malaysia
Experience: 0-4 Years
Job Responsibilities and Expectations:
· Review and validate pre-authorization requests for medical services and procedures.
· Ensure completeness of documentation submitted by policyholders and healthcare providers.
· Verify eligibility and coverage based on policy terms and conditions.
· Coordinate with internal claims and underwriting teams for complex cases.
· Input and update pre-authorization decisions in the claims management system.
· Communicate authorization outcomes to providers and insured members.
· Ensure compliance with Insurance Authority (IA) regulations and internal SOPs.
· Identify and escalate potential fraud or abuse cases to the compliance team.
· Maintain turnaround time (TAT) and service level agreements (SLAs).
· Support audits and quality checks by providing accurate documentation.
· Participate in training sessions to stay updated on regulatory changes.
· Handle sensitive medical information with strict confidentiality.
· 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 claim – and what information may be needed, next steps in processing, etc.
Academic and Additional Qualifications Needed:
· Bachelor’s degree in Nursing, Health Sciences, Insurance, or related field.
· Basic understanding of medical terminology and health insurance policies.
· Proficiency in Cantonese, Mandarin, and English (speak, read, and write).
· Familiarity with Hong Kong’s healthcare system and insurance regulations.
· Strong attention to detail and data entry accuracy.
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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The Cognizant community:
We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive.
- Cognizant is a global community with more than 300,000+ associates around the world.
- We don’t just dream of a better way – we make it happen.
- We take care of our people, clients, company, communities and climate by doing what’s right.
- We foster an innovative environment where you can build the career path that’s right for you.
About us:
Cognizant is one of the world's leading professional services companies, transforming clients' business, operating, and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build, and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant (a member of the NASDAQ-100 and one of Forbes World’s Best Employers 2024) is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com
Cognizant is an equal opportunity employer. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other characteristic protected by federal, state or local laws.
If you have a disability that requires reasonable accommodation to search for a job opening or submit an application, please email [email protected] with your request and contact information.
Disclaimer:
Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.
Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.