Job Information
Cognizant TL - Claims Operation in Kuala Lumpur, KL-Level 30, Malaysia
The Medical Claim Supervisor oversees the medical claims team, ensuring efficient, accurate, and end to end compliant investigation. This leadership role involves managing team performance, implementing process improvements, and ensuing exceptional service delivery while aligning with Goals and Regulatory standards.
List of Duties:
Leading and mentoring the Medical Claims team, setting performance goals, and monitoring KPIs.
Review and assess medical claims, ensuring alignment with policy guidelines and service standards.
Review and process complex claims cases and handle the case escalated by team members
Prepare and analyse the claims data and reports
Collaborate with HK Claims Team to conduct assessment and investigation if needed.
Provide guidance and support to facilitate junior advisors in service delivery and daily operations
Drive continuous improvement initiatives to optimize claims processing workflows
Providing the trend of suspicious case to suggest a FWA dedection framework
Updating the SOP and training note
Preform daily QC to ensure the team's accuracy
Desired Professional Experience:
With 5 - 8 years experience in medical claims processing, including 2 years of supervisory experience
With healthcare background is preferred
With in-depth knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices
With depth knowledge on Fraud, Waste and Abuse (FWA), risk management or compliance frameworks
Strong analytical, presentation and problem-solving capability
Customer-oriented with excellent communication and interpersonal skills
Proficiency in claims management system, data analysis tools and AI
About Cognizant :
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 .
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Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.