Advisor – Claim Operations

3 weeks ago

Melbourne, Victoria, Australia Cognizant Full time

Get AI-powered advice on this job and more exclusive features.

  • Process health insurance claims in accordance with Insurance Authority (IA) regulations.
  • Verify policyholder eligibility and coverage details before claim adjudication.
  • 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 status of a claim – and what information may be needed, next steps in processing, etc.
  • Ensure accurate data entry and documentation of claim details in the system.
  • Coordinate with healthcare providers to validate treatment and billing information.
  • Identify and escalate potential fraud or abuse cases to the compliance team.
  • Maintain turnaround time (TAT) and service level agreements (SLAs) for claims processing.
  • Respond to internal queries related to claim status and documentation.
  • Ensure compliance with internal SOPs and regulatory standards.
  • Support audits by providing required documentation and clarifications.
  • Participate in training sessions on regulatory updates and system enhancements.
  • Maintain confidentiality and data privacy in handling sensitive health information.
  • Collaborate with customer service teams to resolve member inquiries.

Academic and Additional Qualifications Needed:

  • Bachelor's degree in Insurance, Healthcare Administration, or related field.
  • 1–3 years of experience in health insurance claims processing.
  • Basic understanding of health insurance regulatory framework.
  • Proficiency in claims processing systems and MS Office tools.
  • Fluency in Mandarin, Cantonese, and English (speak, read, and write).
Seniority level
  • Seniority levelAssociate
Employment type
  • Employment typeContract
Job function
  • Job functionInformation Technology
  • IndustriesIT Services and IT Consulting

Referrals increase your chances of interviewing at Cognizant by 2x

Get notified about new Process Executive jobs in Greater Kuala Lumpur.

Process Improvement Executive (Fleet Maintenance), SPX Express

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago

Process Executive (voice support)- Mandarin

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago

Process Executive -Customer support-Mandarin

Petaling Jaya, Selangor, Malaysia 4 days ago

Associate/Executive, Human Capital (Talent Acquisition)

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago

Petaling Jaya, Selangor, Malaysia 1 month ago

Customer Support Executive - Srilanka Market

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago

Executive - Land Transport, TMS Implementation

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago

Chief Operating Officer - Specialty & Additives ChemicalProcess Executive (Content Review Associate) - Japanese Speaker

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia MYR2,400.00-MYR3, week ago

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 6 months ago

Relationship Manager, Group Corporate Banking

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 11 months ago

Relationship Manager, Group Corporate Banking

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 8 months ago

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 8 months ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Petaling Jaya, Selangor, Malaysia MYR3,000.00-MYR4, month ago

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 8 months ago

Customer Support Executive (Payment Services)

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

We're unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

#J-18808-Ljbffr

  • Claims Advisor

    2 weeks ago

    Melbourne, Victoria, Australia Marsh Full time

    **Claims Advisor (Claims Operations - Specialty)****What can you expect?**An exciting opportunity has become available for an experienced claims professional to join Marsh's Claims Operations team. In this newly created position, you will be responsible for managing claims and assisting the wider Specialty Claims Team through clear and effective...

  • Claims Advisor

    1 week ago

    Melbourne, Victoria, Australia Zurich Insurance Full time

    **A new adventure awaits**At Zurich we're on a journey, even though we are 100 years young in ANZ, we are lighting the way to a brighter future. A brighter future for you - focused on your career, your wellbeing and your community - as well as our customers and the planet.This exciting adventure will drive positive impact. So, if you want to be part of a...

  • Senior Claims Advisor

    1 week ago

    Melbourne, Victoria, Australia Suncorp Group Full time

    Join to apply for the Senior Claims Advisor role at Suncorp Group2 weeks ago Be among the first 25 applicantsJoin to apply for the Senior Claims Advisor role at Suncorp GroupLead complex claims resolution with autonomy and impactFlexible hybrid working with career development opportunitiesBe part of a values-driven team focused on recovery and fairnessLead...

  • Senior Claims Advisor

    1 week ago

    Melbourne, Victoria, Australia Suncorp Group Full time

    Join to apply for the Senior Claims Advisor role at Suncorp Group2 weeks ago Be among the first 25 applicantsJoin to apply for the Senior Claims Advisor role at Suncorp GroupLead complex claims resolution with autonomy and impactFlexible hybrid working with career development opportunitiesBe part of a values-driven team focused on recovery and fairnessLead...

  • Motor Claims Advisor

    1 week ago

    Melbourne, Victoria, Australia Zurich Insurance Full time

    **About us**At Zurich, being a responsible and impactful business is more than a story we tell. We are passionate about our purpose to 'create a brighter future together', where our voices are diverse, our behaviours are inclusive, our actions drive equity, and our people feel a sense of belonging.There are many reasons why Zurich is the right choice for...

  • Senior Claims Advisor

    2 weeks ago

    Melbourne, Victoria, Australia Marsh & McLennan Companies Full time

    OverviewWe are seeking a talented individual to join our Financial Lines team at Marsh. We are flexible regarding the location of this role. This is a hybrid role that has a requirement of working at least three days a week in the office.Senior Claims AdvisorIn this role, you will provide high-level expertise and manage claims under Directors & Officers...

  • Senior Claims Advisor

    2 weeks ago

    Melbourne, Victoria, Australia Marsh & McLennan Companies Full time

    OverviewWe are seeking a talented individual to join our Financial Lines team at Marsh. We are flexible regarding the location of this role. This is a hybrid role that has a requirement of working at least three days a week in the office.Senior Claims AdvisorIn this role, you will provide high-level expertise and manage claims under Directors & Officers...

  • Senior Claims Advisor – Property And Casualty Lines

    1 week ago

    Melbourne, Victoria, Australia Wtw Full time

    We seek a full-time Senior Claims Advisor with strong property claims experience and some liability background for our Australian Claims Team.This role, based in Melbourne, Sydney, Brisbane, or Perth, may involve managing property claims and require interstate travel.As a Senior Claims Advisor, you will provide technical advice to national clients throughout...

  • Injury And Claims Advisor

    2 weeks ago

    Melbourne, Victoria, Australia Metro Trains Melbourne Full time

    4 December 2024Melbourne Full TimeMetro gets you where you need to go. Shaping our future to be a world-class, sustainable railway for Melbourne is made possible by our people who make a positive difference to every journey.We strive to reflect the community we serve and support the needs of our people who are critical to our success.With Zero Harm at the...

  • Advisor – Claim Operations

    3 weeks ago

    Melbourne, Victoria, Australia Cognizant Full time

    Get AI-powered advice on this job and more exclusive features.Process health insurance claims in accordance with Insurance Authority (IA) regulations.Verify policyholder eligibility and coverage details before claim adjudication.Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across...