Summary of the Role:

The Medical Claim Advisor is responsible for daily claim processing and evaluating medical insurance claims to ensure accuracy, compliance, and timely resolution. The role involves reviewing documentation, verifying coverage and communicating with their seniors to facilitate smooth claim processing.

List of Duties:

• Assess medical claims in compliance with the terms and conditions of the policy
• Verify medical codes, diagnosis and procedure to ensure compliance with industry standards (e.g. ICD 9, ICD 10, CPT)
• Escalate enquiries and complex cases to Senior, when necessary, in line with internal guidelines
• Process claims payment in accordance with the company's objectives and guidelines
• Prepare claim communication letter

Desired Professional Experience:

• Minimum Diploma Holder
• With minimum 1 year of experience in medical claims handling
• A healthcare background is preferred
• With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance policies is preferred
• Strong team player, willing to learn, able to work independently and effectively under pressure
• Fluent in Cantonese, Mandarin, and English (speak, read, and write).