關於這個職位
The client is looking for Team Leads for 3 departments: Claims Excellence, Claims Operations and BD Direct Support.
Claims Excellence
This position requires advanced knowledge of medical claims processes and the ability to identify potential risks or quality issues.
Assist the Assistant Manager/Manager in training and management of the offshore team to ensure operational efficiencies and effectiveness.
Provide ongoing training to Offshore Claims Team and ensure that claim guidelines (as set by HK) are followed and executed efficiently.
Review of offshore team's quality assurance checking to ensure that claim guidelines and practices provide by HK are delivered effectively and upgrading the service quality of the offshore Claims Team (including technical knowledge and servicing skills).
Working collaboratively with HK Claims Excellence team to ensure that SLA error rates are within the benchmark as set by HK and report any breaches immediately to Claim Excellence HK team for handling.
Organizing various kinds of core training events and team / culture building activities.
Claims Operations
The Medical Claim Supervisor oversees the medical claims team, ensuring efficient, accurate, and end to end compliant investigation.
Leading and mentoring the Medical Claims team, setting performance goals, and monitoring KPIs.
Review and assess medical claims, ensuring alignment with policy guidelines and service standards.
Review and process complex claims cases and handle the case escalated by team members.
Prepare and analyze the claims data and reports.
Collaborate with HK Claims Team to conduct assessment and investigation if needed.
Provide guidance and support to facilitate junior advisors in service delivery and daily operations.
Drive continuous improvement initiatives to optimize claims processing workflows.
Providing the trend of suspicious case to suggest a FWA detection framework.
Updating the SOP and training note.
Preform daily QC to ensure the team's accuracy.
BD Direct Support
Supervise and lead the Team with setting performance goals and monitoring KPIs.
Handle the complex case evaluated by representatives.
Collaborate with HK Team to resolve the issues.
Make appropriate recommendations to meet customers’ expectation.
Provide guidance and support to facilitate Representatives in service delivery and daily operations, resolve complex member enquiries and handle complaints escalated from Representatives.
我們希望你具備
- Claims Excellence
- With 5 years of experience in medical claims processing (Both inpatient and outpatient) with 1-year supervisory experience.
- Experience in Claims Quality Assurance is preferred.
- Customer-oriented with excellent communication and interpersonal skills.
- Strong team player, willing to learn, able to work independently and under pressure.
- Self-motivated, analytical and detailed minded in problem solving.
- Good sense of responsibility with high level of integrity and trust.
- Claims Operations
- With 5 - 8 years' experience in medical claims processing, including 2 years of supervisory experience.
- With healthcare background is preferred.
- With in-depth knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance policies.
- With depth knowledge on Fraud, Waste and Abuse (FWA), risk management or compliance frameworks.
- Strong analytical, presentation and problem-solving capability.
- Customer-oriented with excellent communication and interpersonal skills.
- Proficiency in claims management system, data analysis tools and AI.
- BD Direct Support
- With 3 - 5 years of call center experience, including 2 years of experience in people manager.
- Good interpersonal and problem-solving skills.
- Good team player with strong commitment in delivering quality customer service.
- Responsible, well organized and attention to details.
- Proactive, mature, positive and decisive.
- With Professional telephone manner.