Join to apply for the Processor (Claims Operations) role at Cognizant3 days ago Be among the first 25 applicantsJoin to apply for the Processor (Claims Operations) role at CognizantGet AI-powered advice on this job and more exclusive features.Job Title: Processor (Claims Operations)Location: MalaysiaJob Responsibilities And ExpectationsProcess health insurance claims in accordance with Hong Kongs Insurance Authority (IA) regulations.Verify policyholder eligibility and coverage details before claim adjudication.Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product linesAbility to communicate effectively across multiple channels, including phone, e-mail, chat, and textAbility to succinctly collect information from a customer to set up a new claimAbility 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.Ensure accurate data entry and documentation of claim details in the system.Coordinate with healthcare providers to validate treatment and billing information.Identify and escalate potential fraud or abuse cases to the compliance team.Maintain turnaround time (TAT) and service level agreements (SLAs) for claims processing.Respond to internal queries related to claim status and documentation.Ensure compliance with internal SOPs and regulatory standards.Support audits by providing required documentation and clarifications.Participate in training sessions on regulatory updates and system enhancements.Maintain confidentiality and data privacy in handling sensitive health information.Collaborate with customer service teams to resolve member inquiries.Academic And Additional Qualifications NeededBachelors degree in Insurance, Healthcare Administration, or related field.15 years of experience in health insurance claims processing.Basic understanding of Hong Kongs health insurance regulatory framework.Proficiency in claims processing systems and MS Office tools.Fluency in Mandarin, Cantonese, and English (speak, read, and write).About CognizantCognizant (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. 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Job Title
Processor (Claims Operations)