The Company
A Life insurer - Hospital/Out-patient claims (up to 26k)
The Role
- Claims Assessment: Evaluate inpatient, outpatient, and surgical claims against policy terms, pre-authorizations, and coverage exclusions.
- Invoice & Medical Review: Examine hospital bills, itemized receipts, and discharge summaries to verify medical necessity and identify non-payable or inflated charges.
- Stakeholder Coordination: Communicate with hospitals, clinics, and policyholders to obtain missing documentation and resolve claim inquiries.
- Direct Billing: Manage Guarantee of Payment (GOP) processes for hospital admissions and major outpatient treatments.
- Fraud & Quality Control: Identify potential fraud, waste, or billing errors, escalating red flags to management or investigation teams.
- System Entry: Maintain accurate record-keeping of diagnosis codes (ICD-10/CPT) and claim decisions within operational SLAs.
Your Profile
Education & Experience
- Experience: 2+ years in health insurance claims adjudication, TPA operations, or hospital billing.
Technical & Professional Skills
- Good knowledge of insurance products and policy administration processes
- Proficient in Microsoft Office (Excel, Word, Outlook)
- Knowledge of ILAS products and regulatory requirements is an advantage
Apply Today
To apply online (Word attachment only), please click the 'Apply' button. Please note that only short-listed candidates will be contacted.
Reference Number: 67010-0013477395
By clicking 'apply', you give your express consent that Robert Half may use your personal information to process your job application and to contact you from time to time for future employment opportunities. For further information on how Robert Half processes your personal information and how to access and correct your information, please read the Robert Half privacy notice: https://www.roberthalf.com/hk/en/privacy. Please do not submit any sensitive personal data to us in your resume (such as government ID numbers, ethnicity, gender, religion, marital status or trade union membership) as we do not collect your sensitive personal data at this time.
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