Job Responsibilities and Expectations

• – Assist in validating and processing health insurance claims in accordance with Hong Kong Insurance Authority (IA) guidelines.
• – Ensure accurate data entry and documentation of claim details in the claims management system.
• – Support the review of claims for completeness and compliance with policy terms and conditions.
• – Coordinate with internal departments to gather missing documentation or information.
• – Flag potential discrepancies or anomalies for further review.
• – Maintain confidentiality and data protection standards in handling sensitive health information.
• – Respond to basic inquiries from policyholders regarding claim status and documentation requirements.
• – Ensure timely processing of claims to meet service level agreements (SLAs).
• – Assist in generating reports for internal tracking and audit purposes.
• – Stay updated on changes in claims procedures and regulatory requirements in Hong Kong.
• – Support continuous improvement initiatives in claims processing workflows.
• – Participate in training sessions related to claims systems and regulatory updates.
• 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,