Description

Job Responsibilities and Expectations:

• Assist in validating and processing health insurance claims in accordance with 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.

• Fluency in Cantonese, Mandarin, and English (speak, read, and write).

AboutCognizant:
Cognizant (Nasdaq: CTSH) engineers' modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant.