Pre-authorization Service, Consultant

1 week ago

Hong Kong, Central and Western District, Hong Kong SAR China AIA International Limited. Full time

FIND YOUR 'BETTER' AT AIA

We don't simply believe in being 'The Best'. We believe in better - because there's no limit to how far 'better' can take us.

We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.

If you believe in better, we'd love to hear from you.

About the Role

Manage Pre-authorization Service team with the objectives of ensuring smooth operation of processing pre-approval request and answers enquiries from customers and service providers to meet with customers' satisfaction and compliance to company's guidelines and standards.

Responsibilities:

Pre-approval & Hotline Operations

  • Arrange resources to ensure smooth daily operation of operation of pre-approval process and Network provider pre-approval hotline & Nurse line function
  • Supervise team members to resolve both operation and servicing issues encountered and monitor the performance of Pre-approval team in HK Ops
  • Provide case management support
  • Handle Network provider pre-approval hotline & Nurse line duties whenever required
  • Handle non-network pre-approval duties whenever required
  • Coordinate and assist the operations of outsourced hotline operations (non-office hour hotline) and review daily non-office hour hotline call log and follow up issues
  • Review existing end-to-end Pre-approval process and streamline as necessary in order to ensure consistency, accuracy of the output and excellent customer experience
  • Review and improve workflow and system capabilities for efficient delivery of health services to clients and system interface with business partners
  • Review system for enhancement for efficiency and convenience for customers
  • Coordinate with Hotline service & Case Management team and Pre-approval team to ensure smooth operation
  • Provide training to Hotline service & Case Management team and Pre-approval team
Hotline Duties
  • Manage the Provider Pre-approval hotline and Nurse Line to provide excellent customer services and health advice
  • Responds to questions and problems from members and service providers regarding the interpretation and application of procedures concerning member care
  • Handle customer and agent's enquiries and complaints regarding pre-approval process
  • Reviews non-office hours hotlines call log and follow up Pre-approval process
  • Documents call activities in system
Healthcare initiatives and company strategic projects
  • Claims Transformation Project including Customer journey review, provider management and steerage
  • Monitor and closely work with other parties to ensure the smoothness of implementation by predefine target date
  • Responsible for organizing channels' training to promote the use of panel services (i.e. District visit & Operations Forum)
  • New Business initiatives & maintenance - coordinate with different functions to ensure smooth implementation of new business initiatives and performs coaching to team members and maintain its operation to meet with company's requirement and standards
On-site Case Management Support at network providers
  • Handle customers and agents enquiries and complaints regarding all activities in medical insurance policy operation process including Pre-approval, Letter of Guaranteed, Medical Service booking and advice, Claims and In/Outpatient arrangement
  • Follow up on survey result identify area of improvement and action taken to maintain customer satisfaction
Panel claim settlement
  • Monitor the turnaround time on panel claim settlement and ensure the quality and efficiency meet our service standard
  • Ensure smooth implementation on automation and system enhancement
  • Ensure the end-to-end panel settlement and shortfall collection process are streamlined and look for improvement area(s)
Manage provider network
  • Assist Provider Management Team in initiating and maintaining network provider for health services including 1) establish working procedure and identify control process for compliance to ensure service standards and 2) accomplish the requirement for panel network on the submission of pre-approval request and EDI claims submission for accuracy and efficiency.
  • Participate in regular meeting with Panel Network for service review and fee schedule review
Other duties
  • Being the Champion for staff engagement program
  • Other duties and responsibilities as assigned by supervisor
Requirements:
  • University Degree in Business Studies, Nursing / Health Administration or relevant disciplines . Registered nurse is preferred
  • Minimum 3-5 years relevant experience with at least 2 years in Insurance or Healthcare industry
  • Strong interpersonal, communication and analytical skills
  • Good team player and customer focused
  • Self-motivated, willing to take on challenges and able to work under pressure
Others:
  • You are required to obtain relevant license if your job involves in regulated activities
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

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