Process Executive

Process Executive - Pre-Authorization - Health Insurance Join to apply for the Process Executive - Pre-Authorization - Health Insurance role at Cognizant Process Executive - Pre-Authorization - Health Insurance Join to apply for the Process Executive - Pre-Authorization - Health Insurance role at Cognizant Get AI-powered advice on this job and more exclusive features.
Role: Process Executive - Pre-Authorization - Health Insurance Location: KL, Malaysia Experience: 0-4 Years Job Responsibilities And Expectations Review and validate pre-authorization requests for medical services and procedures.
Ensure completeness of documentation submitted by policyholders and healthcare providers.
Verify eligibility and coverage based on policy terms and conditions.
Coordinate with internal claims and underwriting teams for complex cases.
Input and update pre-authorization decisions in the claims management system.
Communicate authorization outcomes to providers and insured members.
Ensure compliance with Insurance Authority (IA) regulations and internal SOPs.
Identify and escalate potential fraud or abuse cases to the compliance team.
Maintain turnaround time (TAT) and service level agreements (SLAs).
Support audits and quality checks by providing accurate documentation.
Participate in training sessions to stay updated on regulatory changes.
Handle sensitive medical information with strict confidentiality.
Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines Ability to communicate effectively across multiple channels, including phone, e-mail, chat, and text Ability to succinctly collect information from a customer to set up a new claim Ability to gather information from multiple source systems to understand and articulate the claim – and what information may be needed, next steps in processing, etc.
Academic And Additional Qualifications Needed Bachelor's degree in Nursing, Health Sciences, Insurance, or related field.
Basic understanding of medical terminology and health insurance policies.
Proficiency in Cantonese, Mandarin, and English (speak, read, and write).
Familiarity with Hong Kong's healthcare system and insurance regulations.
Strong attention to detail and data entry accuracy.
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.
Seniority level Seniority level Entry level Employment type Employment type Full-time Job function Job function Business Development and Sales Industries IT Services and IT Consulting and Business Consulting and Services Referrals increase your chances of interviewing at Cognizant by 2x Sign in to set job alerts for "Process Executive" roles.
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