A Life insurer - Hospital/Out-patient claims (up to 26k) | Hong Kong, HK | In-Office

Job Description

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. Show More