Supervise and train the team of nurses in processing hospitalization claims, ensuring adherence to company policies and industry regulations.
Coordinate with healthcare providers to issue guarantee of payment letters and manage the concurrent review process to optimize patient care and cost management.
Implement strategies to identify cases related to undisclosed medical conditions during underwriting and collaborate with the Special Investigation Unit for further examination.
Maintain SLAs by ensuring prompt response times for hospital inquiries, thereby reducing wait times for patient admissions and discharges.
Develop and manage shift schedules to provide consistent service coverage 365 days a year, from 8 AM to 8 PM.
Continuously assess and improve team performance, workflows, and procedures to enhance customer satisfaction and operational efficiency.
Qualification
Bachelor’s Degree in nursing science
At least 10 years working experience, preferable in insurance industry
Good leadership and people management skill
Logical in decision making
Analytical skill and able to work independently
Outgoing personality, positive attitude and strong contribution for teamwork
