What Jobs are available for Medical Appeals in Hong Kong?

In this position you will.

be managing and handling claims for individual medical and other related products. You will work and build the claims value proposition for the company, and streamline workflow and process design to strive operation excellence.

You will be responsible for…

• Manage the daily operations of the medical claims team and supervise the team performance to provide quality claims service in accordance with the service standards, procedures, guidelines and regulations.
• Ensure all claims are properly handled and review claims processing, decline and settlement procedures when necessary.
• Build service competence in medical claims team by providing suitable coaching, training and development to claims staff.
• Set and monitor reserve adequately and timely and ensure the authority levels laid down are complied with.
• Improve claims service by executing necessary changes to team performance, system and processes.
• Report on Medical claims trend affecting the business result, which may be related to change in market environment and customer dynamics, product coverage or clients with adverse claim experience.
• Assist supervisors in the preparation of management reports and actively drive, run and support projects for the improvement of operation efficiency and service quality.

For you to be successful…

We expect you to be able to demonstrate the following key competencies

Customer Focus

• Demonstrates a customer centric mindset by prioritizing customer needs and addressing concerns with a sense of urgency.
• Aware of the benefits of offering different service solutions to a diversity of customers and helps support adoption.

Curious

• Engages in learning activities and is interested in understanding different ways of doing things including the key activities performed by others in team.
• Understands the value of knowledge sharing and seeks learning in areas beyond own area of focus.
• Keeps up to date on relevant frameworks, applications, software, and/or tools.

Collaborative

• Offers support and contributes to the delivery of shared goals.  Displays loyalty and trust to team.
• Co-operates with team members to resolve problems and achieve goals

Communication

• Communicates clearly and actively listens to others.
• Provides others with information they need in a timely manner.
• Receptive to feedback and appropriately expresses own opinions.

Adaptable

• Adapts to changes quickly, flexibly and easily.
• Handles unexpected requirements and ambiguity in a receptive and calm manner.
• Comfortable using different approaches to problem solving.

You will require the following qualifications and skills

• Degree holder in Insurance/Business Administration or related disciplines
• At least 3 years' experience in General Insurance with hands-on experience on supervision and management in medical claims
• Possessing or in progress of professional insurance qualification such as ACII or ANZIIF is preferred
• Mature, independent, customer-centric, self-motivated, willing to take up new challenges with strong problem-solving skills and leadership skills
• Strong analytical, communication and customer service skills
• Excellent command of written and spoken English and Chinese

Job Description:

In this position you will.

be managing and handling claims for individual medical and other related products. You will work and build the claims value proposition for the company, and streamline workflow and process design to strive operation excellence.

You will be responsible for…

• Manage the daily operations of the medical claims team and supervise the team performance to provide quality claims service in accordance with the service standards, procedures, guidelines and regulations.
• Ensure all claims are properly handled and review claims processing, decline and settlement procedures when necessary.
• Build service competence in medical claims team by providing suitable coaching, training and development to claims staff.
• Set and monitor reserve adequately and timely and ensure the authority levels laid down are complied with.
• Improve claims service by executing necessary changes to team performance, system and processes.
• Report on Medical claims trend affecting the business result, which may be related to change in market environment and customer dynamics, product coverage or clients with adverse claim experience.
• Assist supervisors in the preparation of management reports and actively drive, run and support projects for the improvement of operation efficiency and service quality.

For you to be successful…

We expect you to be able to demonstrate the following key competencies :

• Customer Focus

• Demonstrates a customer centric mindset by prioritizing customer needs and addressing concerns with a sense of urgency.

• Aware of the benefits of offering different service solutions to a diversity of customers and helps support adoption.

• Curious

• Engages in learning activities and is interested in understanding different ways of doing things including the key activities performed by others in team.

• Understands the value of knowledge sharing and seeks learning in areas beyond own area of focus.
• Keeps up to date on relevant frameworks, applications, software, and/or tools.

• Collaborative

• Offers support and contributes to the delivery of shared goals. Displays loyalty and trust to team.

• Co-operates with team members to resolve problems and achieve goals

• Communication

• Communicates clearly and actively listens to others.

• Provides others with information they need in a timely manner.
• Receptive to feedback and appropriately expresses own opinions.

• Adaptable

• Adapts to changes quickly, flexibly and easily.

• Handles unexpected requirements and ambiguity in a receptive and calm manner.
• Comfortable using different approaches to problem solving.

You will require the following qualifications and skills:

• Degree holder in Insurance/Business Administration or related disciplines
• At least 3 years' experience in General Insurance with hands-on experience on supervision and management in medical claims
• Possessing or in progress of professional insurance qualification such as ACII or ANZIIF is preferred
• Mature, independent, customer-centric, self-motivated, willing to take up new challenges with strong problem-solving skills and leadership skills
• Strong analytical, communication and customer service skills
• Excellent command of written and spoken English and Chinese

The Role:

We are looking for a highly motivated and experienced Senior Manager to lead our Medical Claims team. You will be responsible for managing and developing technical and servicing strategies for Group Medical and Individual Healthcare claims, ensuring the highest service quality for both internal and external customers.

Key Responsibilities:

• Lead and develop a team of claims professionals
• Implement strategies and digital tools to streamline claims processes
• Ensure prompt and accurate claims processing and decision-making
• Implement robust fraud prevention measures
• Participate in marketing activities to support new business initiatives
• Prepare monthly statistical and analytical claims reports
• Monitor and assess the performance of service providers
• Provide coaching and training to subordinates

Requirements:

• Degree holder, preferably in Healthcare Management or related disciplines
• Over 8 years of experience in medical claims management
• Strong exposure in Group Medical and Individual Medical Insurance
• Solid knowledge in medical terminology and medical claims processes
• Proficient in digital tools and software in claims processing
• Excellent leadership, communication, analytical, problem-solving, decision-making and stakeholder management skills
• Customer-centric, self-motivated, detail-minded with strong business acumen and market sense
• Excellent command of written and spoken English and Chinese

Bowtie's mission is to make insurance good again and our vision is to build a category-defining health insurance company.

As a young and fast-growing company, grooming and learning from the next generation is always our priority. We are looking for great talents who share our values to join us in our medical claims team (individual medical insurance, VHIS focused).

• Claims assessment and processing, including pre-approval case, inpatient and outpatient claim

• communicate with claims customer on claims decision

• prepare regular reports and statistics

• participate in projects of system enhancement and new product development

• handle administrative support duties in the claims area

• Minimum of 2 years of claims experience in medical claims (both in-patient, out-patient claims and pre-approval)

• Prior experience in VHIS (Voluntary Health Insurance Scheme) medical claims assessment

• good communication skills with customers

• Independent, self-motivated, a good team player, and able to work under pressure

• strong analytical and independent problem-solving capability

• Good PC skills in MS Words, EXCEL, Powerpoint

Candidates with more experience will be considered as Senior Claims Officer.

Apart from a great career path and an opportunity to do good and do well, we also offer:

• • Competitive package
• Flexible working hours
• Benefits include medical/ dental coverage and wellness programs
• Fun, co-operative, and flexible startup culture
• Weekly sharing sessions and regular social gatherings
• Excellent learning opportunities with Professional Development Sponsorship

We are the first licensed virtual insurer (虛擬保險公司) in Hong Kong.

We believe that insurance is fundamentally good, and we are here to bring the good back through our passionate, innovative, and customer-centric team.

By combining our deep domain expertise and our own proprietary modern technology, we are building one of the most iconic, category-defining health insurance companies in Asia.

We take pride in moving fast all the time and our track record in moving ahead in the game. Our digital insurance platform is also ranked #2 in the world in Sia Partners' 2023 report.

As we grow, we're always looking for highly dynamic, hands-on, and passionate talent to join our team. If you are looking for a rewarding career where you will grow together with strong talents from different backgrounds and build products and services that bring a positive impact on the lives of millions of people in Hong Kong / Asia, apply to our opening today

Information collected will be treated in strict confidence and used solely for recruitment purposes.

The company will retain all applications no longer than 24 months of which will be destroyed thereafter.

We are an equal-opportunity employer. We do not discriminate on the basis of race, sex, disability, or family status in the employment process.

Job Responsibilities:

• Claim Adjudication

->Outpatient provider claims assessment
- Claims input or data upload
- Claims create batch and filling
- Payment generation and CHQ/Autopay Advice handling
- Coordination on Administrative issue

1. ->Enrollment
2. ->UAT and IT enhancement
3. ->Statistics

4. ->Scanning

5. Handle provider telephone and email enquiry

6. Provide administrative support for schemes
7. Others special or adhoc tasks assigned by supervisor

Job Requirement:

• Diploma or above (major in Science subject is preferred), Holder of Diploma below with over 5 years of relevant experience will be also considered.
• 1 year relevant working experience in the medical claim field.
• Responsible, self-motivated, detail-oriented and be able to work in a team environment
• Proficiency in MS Office
• Strong sense at figures
• Excellent communication skills in both written and spoken English and Cantonese
• Good team player

Personal data collected will be used for recruitment purposes only. Bupa will be in touch for any opportunities that matches your profile. All personal data of unsuccessful application will be destroyed 24 months from the date of receiving the application. Full version of Data Privacy Notice available upon request.

Job Responsibilities:

• Assess and approve life claims according to the company's policies and objectives
• Collaborate with medical professionals and customers to conduct assessments and investigations
• Investigating claims fraud case
• Communicate and follow up with health providers, hospitals, and investigators involved in the claims process
• Provide high-quality customer service and handle complaints on claims
• Prepare regular management and business reports of Claims Department
• Coordinate and assist in UAT activities such as preparation of test plan, test cases, pre-UAT quality check, monitoring of bug fixing, retest progress, UAT reports and post implementation monitoring
• Prepare timely reports on investigation activities and provide sound recommendations

Requirements:

• Degree holder with professional qualifications in insurance or related disciplines
• Minimum 3 years of experience in life and medical claim processing;
• Customer-oriented with excellent communication and interpersonal skills
• Effective team player, eager to learn, able to work independently and under pressure
• Self-motivated, analytical, and detail-oriented in problem-solving
• High sense of responsibility, integrity, and trustworthiness
• Proficient in both written and spoken English and Chinese
• Skilled in using MS Word, Excel, and Chinese word processing software

The Role:

We are looking for a highly motivated and experienced Senior Manager to lead our Medical Claims team. You will be responsible for managing and developing technical and servicing strategies for Group Medical and Individual Healthcare claims, ensuring the highest service quality for both internal and external customers.

Key Responsibilities:

• Lead and develop a team of claims professionals
• Implement strategies and digital tools to streamline claims processes
• Ensure prompt and accurate claims processing and decision-making
• Implement robust fraud prevention measures
• Participate in marketing activities to support new business initiatives
• Prepare monthly statistical and analytical claims reports
• Monitor and assess the performance of service providers
• Provide coaching and training to subordinates

Requirements:

• Degree holder, preferably in Healthcare Management or related disciplines
• Over 8 years of experience in medical claims management
• Strong exposure in Group Medical and Individual Medical Insurance
• Solid knowledge in medical terminology and medical claims processes
• Proficient in digital tools and software in claims processing
• Excellent leadership, communication, analytical, problem-solving, decision-making and stakeholder management skills
• Customer-centric, self-motivated, detail-minded with strong business acumen and market sense
• Excellent command of written and spoken English and Chinese

Job Responsibilities:

• Claim Adjudication

->Outpatient provider claims assessment
- Claims input or data upload
- Claims create batch and filling
- Payment generation and CHQ/Autopay Advice handling
- Coordination on Administrative issue

1. ->Enrollment
2. ->UAT and IT enhancement
3. ->Statistics

4. ->Scanning

5. Handle provider telephone and email enquiry

6. Provide administrative support for schemes
7. Others special or adhoc tasks assigned by supervisor

Job Requirement:

• Diploma or above (major in Science subject is preferred), Holder of Diploma below with over 5 years of relevant experience will be also considered.
• 1 year relevant working experience in the medical claim field.
• Responsible, self-motivated, detail-oriented and be able to work in a team environment
• Proficiency in MS Office
• Strong sense at figures
• Excellent communication skills in both written and spoken English and Cantonese
• Good team player

Personal data collected will be used for recruitment purposes only. Bupa will be in touch for any opportunities that matches your profile. All personal data of unsuccessful application will be destroyed 24 months from the date of receiving the application. Full version of Data Privacy Notice available upon request.

Bowtie's mission is to make insurance good again and our vision is to build a category-defining health insurance company.

As a young and fast-growing company, grooming and learning from the next generation is always our priority. We are looking for great talents who share our values to join us in our medical claims team (individual medical insurance, VHIS focused).

• Claims assessment and processing, including pre-approval case, inpatient and outpatient claim

• communicate with claims customer on claims decision

• prepare regular reports and statistics

• participate in projects of system enhancement and new product development

• handle administrative support duties in the claims area

• Minimum of 2 years of claims experience in medical claims (both in-patient, out-patient claims and pre-approval)

• Prior experience in VHIS (Voluntary Health Insurance Scheme) medical claims assessment

• good communication skills with customers

• Independent, self-motivated, a good team player, and able to work under pressure

• strong analytical and independent problem-solving capability

• Good PC skills in MS Words, EXCEL, Powerpoint

Candidates with more experience will be considered as Senior Claims Officer.

Apart from a great career path and an opportunity to do good and do well, we also offer:

• • Competitive package
• Flexible working hours
• Benefits include medical/ dental coverage and wellness programs
• Fun, co-operative, and flexible startup culture
• Weekly sharing sessions and regular social gatherings
• Excellent learning opportunities with Professional Development Sponsorship

We are the first licensed virtual insurer (虛擬保險公司) in Hong Kong.

We believe that insurance is fundamentally good, and we are here to bring the good back through our passionate, innovative, and customer-centric team.

By combining our deep domain expertise and our own proprietary modern technology, we are building one of the most iconic, category-defining health insurance companies in Asia.

We take pride in moving fast all the time and our track record in moving ahead in the game. Our digital insurance platform is also ranked #2 in the world in Sia Partners' 2023 report.

As we grow, we're always looking for highly dynamic, hands-on, and passionate talent to join our team. If you are looking for a rewarding career where you will grow together with strong talents from different backgrounds and build products and services that bring a positive impact on the lives of millions of people in Hong Kong / Asia, apply to our opening today

Information collected will be treated in strict confidence and used solely for recruitment purposes.

The company will retain all applications no longer than 24 months of which will be destroyed thereafter.

We are an equal-opportunity employer. We do not discriminate on the basis of race, sex, disability, or family status in the employment process.