Vice President of Business Administration leading strategic programs and business administration for Care organization. Collaborating with leadership and managing large initiatives for operational effectiveness.
About the role
- Senior Claims Administrator managing and negotiating pre-authorization and Letter of Guarantee requests. Reviewing medical admissions and ensuring adherence to policy terms and conditions while providing stakeholder updates.
Responsibilities
- Review and assess pre-authorization and Letter of Guarantee (LOG/GOP) requests to ensure alignment with policy terms and conditions.
- Evaluate medical information, treatment plans, and cost estimates to determine coverage eligibility.
- Negotiate with healthcare providers to secure preferential rates
- Ensure timely and accurate communication with hospitals, members, brokers, and internal teams regarding case status and decisions including inbound and outbound calls, fax and email.
- Monitor ongoing cases and provide updates to all relevant parties throughout the admission or treatment process.
- Identify potential risks such as non-disclosure, policy exclusions, or overutilization of benefits.
- Coordinate with medical advisors and underwriting teams when additional review or clarification is required.
- Ensure all documentation and decisions are properly recorded in the system in compliance with company standards.
- Finalize cases, ensuring completeness, accuracy, and proper closure within service level agreements (SLAs).
- Handle more complex or sensitive cases.
- Take ownership of cases requiring advanced knowledge, deeper analysis, or cross-team coordination.
- Assist in reviewing cases handled by junior staff by provide guidance, quality checks, and feedback to ensure accuracy and adherence to processes.
Requirements
- University degree in medical discipline is a strong plus
- Excellent command of the English, Cantonese language. Mandarin would also be an asset for the role.
- Proficient in using computers, Microsoft Office, Internet, and E-mail
- 5+ years of experience in letter of guarantee (LOG)/preauthorization issuance or claims processing in medical/life insurance
- Able to analyze and interpret medical information, product features, research data, and synthesize information.
- Able to adapt and work well in a multi-cultural environment.
- Excellent communication skills both spoken and written
- Flexible and able to multitask effectively in a fast-paced environment
- Strong time management and organizational skills
- IIQE Paper 1 & 2 certified, or willing to obtain certification within 3 months of joining.
Benefits
- Flexible work arrangements
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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