Specialist Claim Hospital Fax (Claim Assessor)

Key Responsibilities

Hospital Fax Claims

• Provide supports to team in handling the fax claims from the hospital
• Check the information from fax claims documents, and record into the system
• Investigate and make decision for claims in the system, by covering the below actions:
• Approve for the payment base on authorization
• Perform rejection of fax claims received
• Require the additional information
• Issue memo into the system for administration in performing next steps
• Submit for further investigation
• Request the hospital records from hospital
• Continuously monitor and make decision for the pending cases of Claims Hospital Fax, or back log

Hospital assessment Claims (OPD cashless)

• Provide support team in handling the OPD cashless claims from the hospital
• Perform investigation and make decision for OPD cashless claims received in the system
• Approve for the payment base on authorization
• Perform rejection of fax claims received
• Require the additional information
• Issue memo into the system for administration in performing next steps
• Submit for further investigation
• Request the hospital records from hospital
• Continuously monitor and make decision for the pending cases of OPD cashless Claims Hospital or back log
• Consolidate/manage the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization
• Report- Collect the information, and support Manager - Claims Hospital Fax in providing the daily and monthly reports regarding to volume and turnaround time of Claims Hospital Fax
• Give consult / advise medical related to jr. claim assessor or others

Must Have