Description

The Medical Claim Supervisor oversees the medical claims team, ensuring efficient, accurate, and end to end compliant investigation. This leadership role involves managing team performance, implementing process improvements, and ensuing exceptional service delivery while aligning with Goals and Regulatory standards.

List of Duties:

1. Leading and mentoring the Medical Claims team, setting performance goals, and monitoring KPIs.
2. Review and assess medical claims, ensuring alignment with policy guidelines and service standards.
3. Review and process complex claims cases and handle the case escalated by team members
4. Prepare and analyse the claims data and reports
5. Collaborate with HK Claims Team to conduct assessment and investigation if needed.
6. Provide guidance and support to facilitate junior advisors in service delivery and daily operations
7. Drive continuous improvement initiatives to optimize claims processing workflows
8. Providing the trend of suspicious case to suggest a FWA dedection framework
9. Updating the SOP and training note
10. Preform daily QC to ensure the team's accuracy

Desired Professional Experience:

1. With 5 - 8 years experience in medical claims processing, including 2 years of supervisory experience
2. With healthcare background is preferred
3. With in-depth knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices
4. With depth knowledge on Fraud, Waste and Abuse (FWA), risk management or compliance frameworks
5. Strong analytical, presentation and problem-solving capability
6. Customer-oriented with excellent communication and interpersonal skills
7. Proficiency in claims management system, data analysis tools and AI

About Cognizant :

Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant .