Claims Assessor

Job description / Role

On behalf of a client, (An international Health Insurance provider, with headquarters in Hong Kong) we are looking for Claims Assessor (mandarin speaker) to join their team in Dubai.

OVERALL PURPOSE OF JOB:To provide best in class customer and clinical service support by handling customer inquiries, service provider inquiries, claims pre-authorizations and case/care management services. The job holder must communicate as necessary with Clients, Brokers, Medical Service providers, emergency assistance companies and other third parties and maintain excellent ongoing working relationships with all external stakeholders and suppliers.

KEY DUTIES & RESPONSIBILITIES:

Claims
- Deliver timely and accurate claims administration services: claims adjudication, data entry, production of claims correspondence such as claims settlements, declination, information requests, etc.
- Establish and maintain excellent knowledge of the company's products, claims handling procedures and systems
- Assess claims as per defined work flows and delegated authority limits.
- Follow referral procedures on claims which are outside delegated authorities while dealing with medical review, case management, recovery claims, possible abuse & fraud and complete claim file.

Customer Service:
- Be the primary contact for customers / brokers / medical service providers. Handle all inquiries on the phone, via website live chat, via email and letter.
- Communicate and maintain excellent interpersonal relationships with Clients, Brokers, medical service providers, other third parties and other departments and offices.
- Take responsibility for ensuring that the service delivered to the customer are appropriate to the customer’s need and that the customer is treated in a fair, ethical and consistent manner.
- Ensure all queries and service requests are dealt with promptly and within company specified time frames or as promised to the customer.
- Resolve complaints and service failures, and adhere to the complaints record-keeping and escalation procedures.
- Ensure that the above is handled accurately, aiming at zero errors.
- Ensure that customer feedback is properly routed, and work together with the management to address areas of improvement; thus, enhancing the customer experience.
- Check the work queue on the CRM on a daily basis and allocate the work queue items to the relevant department for action.
- Ensure all customer documentation is complete prior to forwarding it to the relevant department.
- Follow up with customers / brokers on any missing information on the application.
- Ensure all customers / brokers communication is recorded on the CRM.
- Conduct quality checks on all data entered on CRM and all documentation to be sent to the customer.

Clinical Services:
- Handle pre-certification of out-patient, day-patient and in-patient treatments by coordinating treatment needs with the benefits offered in the insurance plan.
- Liaise with doctors and providers to obtain necessary and accurate medical information within stipulated time frame.
- As and when necessary, coordinate with the company's emergency assistance providers for inpatient emergency admissions and where relevant, emergency evacuation protocols
- Apply prudent cost management measures by coordinating the provision of only medically necessary and appropriate health services.

General:
- Maintain a very high standard of quality in terms of business integrity and the customer experience.
- Act in a highly professional and courteous manner at all times.
- Adhere to Best Practice Processes, Client Services Standards and to all relevant statutory or regulatory requirements, including treating customers fairly and other initiatives. Work flexibly within the team to support changing business needs.
- Ensure that the company’s brand values, principles, and styles are adopted and utilized for all external communication.

Compliance and Security
- Take responsibility for establishing and maintaining up-to-date personal awareness of all legislative, regulatory and Company-specific rules, policies and procedures related to performance of your role. Ensure consistent compliance with legal, regulatory and Company standards in line with underwriter requirements.
- Pay particular attention to the Company’s Information and Data Security policies when accessing and using all Company systems which may provide you with access to sensitive information assets, and strive to maintain the highest possible standards of information protection at all times.
- Take individual responsibility for accessing only the systems, records and information required to perform your role. Treat all data contained within those systems in a manner consistent with the Company’s Information and Data Security policies, and in line with the confidentiality clauses provided within your employment contract.

Requirements

KNOWLEDGE SKILLS AND EXPERIENCE REQUIRED
- Comprehensive experience in a customer and clinical service delivery environment, preferably gained via the international private medical insurance industry. Previous medical claims handling experience is an advantage.
- A clinical qualification to at least RN level supported by a solid educational background (degree level of equivalent) is essential.
- A demonstrable record in providing excellent service to people at all levels in a multicultural environment.
- Excellent communication skills; able to confidently and sensitively handle both written and verbal correspondence with providers, brokers, members and colleagues.
- Willing to thoroughly learn and understand the plans and policies offered by the company.
- A high degree of IT literacy, including experience in working with a CRM system whereby all details of the customer, communication and service levels can be maintained and monitored.
- Willing to thoroughly learn and understand the plans and policies offered by the company.
- Business-level English and Mandarin (written, spoken and reading comprehension) is essential. Additional local language skills are advantageous.
- Able to work extended hours on occasions when required.

About the Company

Transguard Workforce Solutions delivers Professional Contract Staffing (also known as Employee Outsourcing) within the UAE.

Our Workforce Solutions include:

• Delivering Sourcing and Recruitment Solutions for Clients in need of identifying Contract or temporary Staff.

• Providing a complete end to end Staffing Solution which includes Visa Sponsorship, HR Management, Employee Welfare & Payroll Services.

• Transitioning Contract Staff from other staffing providers to Transguard while remaining compliant with UAE Labour and Immigration Laws.

Transguard Workforce Solutions currently employ over 2000+ Staff from over 70 different nationalities. Across the Group, we payroll over 70,000 employees monthly.