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Job Description Summary
Responsible for performing pre-certification; prospective, concurrent and retrospective review of hospitalization; and to ensure that cost containment measures are carried out without compromising on the care quality and service standards.

Roles and Responsibilities:

• To support and lead a team of assessors in pre-certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company’s requirements and guidelines.

• To ensure quality audits are done for the respective team members.

• To pre-certify cases for issuance of guarantee letter in compliance to Company’s requirements and guidelines assist the team target productivity benchmark.

• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.

• To assist in the assignment and monitoring of all documents received in their respective team’s queues.

• To assist WFM team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the GL process.

• To ensure huddles and communications are carried out as per the agreed frequency.

• To ensure coaching and engagement activities are carried out for performance improvement and cost containment.

• To ensure that cases of fee disputes are handled and resolved within targeted TAT.

• To ensure that error rate in GL issuance is less that the target.

• To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements.

Minimum Job Requirements:

• Education: Bachelor's Degree in Medicine or medical fields

• Years of Experience: Minimum 2 years of experience

• Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge

• Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs

• Language: English and Bahasa Malaysia

Build a career with us as we help our customers and the community live healthier, longer, better lives.

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