Claims Auditor

2 weeks ago

Hong Kong, Central and Western District, Hong Kong SAR China Mercer Full time

The role: Quality Assurance Analyst

The primary responsibility of this position is to ensure quality of customer service, correctness of claims assessment and also to review the claims operations process follow agreed procedures.

The role is also required to provide a broad range of account servicing support to Mercer employee benefits clients, including coordination with clients, consultants, and insurance companies on medical claims administration activities and client enquiries.

We will rely on you to:

  • Audit/monitor performance of Service Delivery Team, audit scope covers Contact Centre claims related enquiry and claims input/adjudication/reimbursement/reconciliation.
  • Prepare analytical audit results period to identify the risks and areas of improvement.
  • Handle claims related complaints escalation
  • Support policy renewal
  • Review existing process flow and recommend area of improvement
  • Work with the processing team lead to provide various types of training programs to the Service Delivery Team.
  • Coordination between Service Delivery Team and Hong Kong Health Business Team.
  • Support claims administration of VIP

What you need to have:

  • Post secondary diploma / degree or above.
  • 3+ years of working experience in medical claims adjudication
  • Understanding of principles of insurance policies and claims
  • Ability to prioritize, meet tight deadlines, and handle multiple tasks
  • Spoken and written proficiency in English
  • Excellent in MS Office, especially in Excel and Access
  • Having customer service contact center experiences and/or QA processing will be added advantage.

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