Claims Excellence- Hong Kong::Coimbatore

Claims Excellence - Health Insurance (Hong Kong)

Processor Role

Job Responsibilities and Expectations

• - Assist in validating and processing health insurance claims in accordance with Hong Kong Insurance Authority (IA) guidelines.
• - Ensure accurate data entry and documentation of claim details in the claims management system.
• - Support the review of claims for completeness and compliance with policy terms and conditions.
• - Coordinate with internal departments to gather missing documentation or information.
• - Flag potential discrepancies or anomalies for further review.
• - Maintain confidentiality and data protection standards in handling sensitive health information.
• - Respond to basic inquiries from policyholders regarding claim status and documentation requirements.
• - Ensure timely processing of claims to meet service level agreements (SLAs).
• - Assist in generating reports for internal tracking and audit purposes.
• - Stay updated on changes in claims procedures and regulatory requirements in Hong Kong.
• - Support continuous improvement initiatives in claims processing workflows.
• - Participate in training sessions related to claims systems and regulatory updates.
• 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.

Academic and Additional Qualifications Needed

• - Bachelor’s degree in Insurance, Business Administration, Healthcare Management, or related field.
• - Basic understanding of health insurance products and claims lifecycle.
• - Proficiency in Microsoft Office and claims management software.
• - Strong attention to detail and organizational skills.