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.
#LI-CTSAPAC
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.
What we offer
- The chance to work with impact. Here, you’re empowered to bring your biggest thinking to help our company and clients improve everyday life.
- Ownership over your career. Stay at the top of your game through our award-winning learning and development ecosystem. And when your ambitions change or we offer new opportunities, we help you pivot by providing reskilling, on-the-job learning and guidance to find new roles that might be a better fit.
- The opportunity to thrive on a high-caliber team with heart. We celebrate each other’s experiences and perspectives and promote a sense of belonging through our affinity groups and diversity and inclusion initiatives.
- A comprehensive total rewards package, including a competitive salary and pension plan with matching contributions.
- Flexible health and financial benefits to support you and your eligible dependents—from day one.
- True work-life balance. Be at your best through paid time off, flexible work arrangements, volunteering opportunities, social events, and so much more.
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 apply, 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.