2 Medical Appeals jobs in Vietnam
Hotline Healthcare Claims Manager
Manulife
Posted 22 days ago
Job Viewed
Job Description
**Responsibilities:**
+ Handling 24/7 inbound and outbound calls about customers and sales' Healthcare claims concerns, enquiries and complaints in a timely manner and in accordance with company's policy, providing right information, appropriate solutions and alternatives;
+ Handling hospitals/medical providers' enquiries for arrangement of direct billing services to MVL's clients;
+ Contribution as Subject Matter Expert in projects relating to enhance healthcare services;;
+ Collaboration with cross departments/functions to smoothly solve all claims-related issues and reach claims objectives;
+ Duties to support Department targets and Company objectives as and when assigned by Team leader/Line Manager.
**What we're looking for:**
+ EDUCATION / TRAININGUniversity or College DegreeEnglish intermediate is preferred
+ PROFESSIONAL / TRADE QUALIFICATIONInsurance Business
+ COMPETENCIESHard working, honesty, be able to work under high pressureNegotiationProblem solving skill
+ EXPERIENCE
Having experience at least 3 years in insurance.
+ COMPUTER PROFICIENCY
MS Office
+ KEY WORKING RELATIONSHIP
Good attitude and respect colleagues
Team work
**When you join our team:**
+ We'll empower you to learn and grow the career you want.
+ We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
+ As part of our global team, we'll support you in shaping the future you want to see.
**Acerca de Manulife y John Hancock**
Manulife Financial Corporation es un importante proveedor internacional de servicios financieros que ayuda a las personas a tomar decisiones de una manera más fácil y a vivir mejor. Para obtener más información acerca de nosotros, visite .
**Manulife es un empleador que ofrece igualdad de oportunidades**
En Manulife/John Hancock, valoramos nuestra diversidad. Nos esforzamos por atraer, formar y retener una fuerza laboral tan diversa como los clientes a los que prestamos servicios, y para fomentar un entorno laboral inclusivo en el que se aprovechen las fortalezas de las culturas y las personas. Estamos comprometidos con la equidad en las contrataciones, la retención de talento, el ascenso y la remuneración, y administramos todas nuestras prácticas y programas sin discriminación por motivos de raza, ascendencia, lugar de origen, color, origen étnico, ciudadanía, religión o creencias religiosas, credo, sexo (incluyendo el embarazo y las afecciones relacionadas con este), orientación sexual, características genéticas, condición de veterano, identidad de género, expresión de género, edad, estado civil, estatus familiar, discapacidad, o cualquier otro aspecto protegido por la ley vigente.
Nuestra prioridad es eliminar las barreras para garantizar la igualdad de acceso al empleo. Un representante de Recursos Humanos trabajará con los solicitantes que requieran una adaptación razonable durante el proceso de solicitud. Toda la información que se haya compartido durante el proceso de solicitud de adaptación se almacenará y utilizará de manera congruente con las leyes y las políticas de Manulife/John Hancock correspondientes. Para solicitar una adaptación razonable en el proceso de solicitud, envíenos un mensaje a .
**Modalidades de Trabajo**
En la oficina
+ Handling 24/7 inbound and outbound calls about customers and sales' Healthcare claims concerns, enquiries and complaints in a timely manner and in accordance with company's policy, providing right information, appropriate solutions and alternatives;
+ Handling hospitals/medical providers' enquiries for arrangement of direct billing services to MVL's clients;
+ Contribution as Subject Matter Expert in projects relating to enhance healthcare services;;
+ Collaboration with cross departments/functions to smoothly solve all claims-related issues and reach claims objectives;
+ Duties to support Department targets and Company objectives as and when assigned by Team leader/Line Manager.
**What we're looking for:**
+ EDUCATION / TRAININGUniversity or College DegreeEnglish intermediate is preferred
+ PROFESSIONAL / TRADE QUALIFICATIONInsurance Business
+ COMPETENCIESHard working, honesty, be able to work under high pressureNegotiationProblem solving skill
+ EXPERIENCE
Having experience at least 3 years in insurance.
+ COMPUTER PROFICIENCY
MS Office
+ KEY WORKING RELATIONSHIP
Good attitude and respect colleagues
Team work
**When you join our team:**
+ We'll empower you to learn and grow the career you want.
+ We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
+ As part of our global team, we'll support you in shaping the future you want to see.
**Acerca de Manulife y John Hancock**
Manulife Financial Corporation es un importante proveedor internacional de servicios financieros que ayuda a las personas a tomar decisiones de una manera más fácil y a vivir mejor. Para obtener más información acerca de nosotros, visite .
**Manulife es un empleador que ofrece igualdad de oportunidades**
En Manulife/John Hancock, valoramos nuestra diversidad. Nos esforzamos por atraer, formar y retener una fuerza laboral tan diversa como los clientes a los que prestamos servicios, y para fomentar un entorno laboral inclusivo en el que se aprovechen las fortalezas de las culturas y las personas. Estamos comprometidos con la equidad en las contrataciones, la retención de talento, el ascenso y la remuneración, y administramos todas nuestras prácticas y programas sin discriminación por motivos de raza, ascendencia, lugar de origen, color, origen étnico, ciudadanía, religión o creencias religiosas, credo, sexo (incluyendo el embarazo y las afecciones relacionadas con este), orientación sexual, características genéticas, condición de veterano, identidad de género, expresión de género, edad, estado civil, estatus familiar, discapacidad, o cualquier otro aspecto protegido por la ley vigente.
Nuestra prioridad es eliminar las barreras para garantizar la igualdad de acceso al empleo. Un representante de Recursos Humanos trabajará con los solicitantes que requieran una adaptación razonable durante el proceso de solicitud. Toda la información que se haya compartido durante el proceso de solicitud de adaptación se almacenará y utilizará de manera congruente con las leyes y las políticas de Manulife/John Hancock correspondientes. Para solicitar una adaptación razonable en el proceso de solicitud, envíenos un mensaje a .
**Modalidades de Trabajo**
En la oficina
This advertiser has chosen not to accept applicants from your region.
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Senior Healthcare Claims Analyst - Remote
60000 Pleiku, Gia Lai
WhatJobs
Posted 2 days ago
Job Viewed
Job Description
Our client, a leading entity in the healthcare sector, is seeking a highly skilled Senior Healthcare Claims Analyst to join their fully remote team. This critical role involves the meticulous review, adjudication, and analysis of complex medical claims. You will play a vital part in ensuring the accuracy and integrity of claims processing, identifying fraudulent activities, and contributing to the financial health of our operations. The ideal candidate will possess a strong background in medical coding, insurance principles, and regulatory compliance, coupled with exceptional analytical acumen.
Key Responsibilities:
Key Responsibilities:
- Review and adjudicate high-volume, complex medical insurance claims in accordance with company policies, benefit plans, and regulatory guidelines.
- Analyze claims data to identify patterns, trends, and anomalies indicative of errors, overpayments, or potential fraud.
- Investigate and resolve claims issues, collaborating with providers, members, and internal departments as necessary.
- Interpret medical policies, EOBs (Explanation of Benefits), and provider contracts to ensure correct claim processing.
- Provide guidance and mentorship to junior claims analysts, fostering a culture of accuracy and efficiency.
- Contribute to the development and refinement of claims processing procedures and guidelines.
- Prepare detailed reports on claims analysis, findings, and recommendations for process improvements.
- Stay current with changes in healthcare regulations, coding updates (e.g., ICD-10, CPT), and insurance industry best practices.
- Maintain confidentiality and adhere to data privacy regulations (e.g., HIPAA, relevant Vietnamese data protection laws).
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field.
- Minimum of 5 years of experience in health insurance claims processing, medical billing, or healthcare administration.
- In-depth knowledge of medical coding systems (ICD-10, CPT, HCPCS) and insurance terminology.
- Proficiency in claims adjudication software and healthcare IT systems.
- Strong analytical and problem-solving skills, with meticulous attention to detail.
- Excellent written and verbal communication skills.
- Ability to work independently and manage time effectively in a remote work environment.
- Understanding of healthcare regulations and compliance requirements.
- Relevant certifications (e.g., CPC, CHFP) are a plus.
This advertiser has chosen not to accept applicants from your region.
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