Process Executive - Pre-Authorization - Health Insurance
Join to apply for the Process Executive - Pre-Authorization - Health Insurance role at Cognizant
Process Executive - Pre-Authorization - Health Insurance
Join to apply for the Process Executive - Pre-Authorization - Health Insurance role at Cognizant
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Role: Process Executive - Pre-Authorization - Health Insurance
Location: KL, Malaysia
Experience: 0-4 Years
Job Responsibilities And Expectations
* Review and validate pre-authorization requests for medical services and procedures.
* Ensure completeness of documentation submitted by policyholders and healthcare providers.
* Verify eligibility and coverage based on policy terms and conditions.
* Coordinate with internal claims and underwriting teams for complex cases.
* Input and update pre-authorization decisions in the claims management system.
* Communicate authorization outcomes to providers and insured members.
* Ensure compliance with Insurance Authority (IA) regulations and internal SOPs.
* Identify and escalate potential fraud or abuse cases to the compliance team.
* Maintain turnaround time (TAT) and service level agreements (SLAs).
* Support audits and quality checks by providing accurate documentation.
* Participate in training sessions to stay updated on regulatory changes.
* Handle sensitive medical information with strict confidentiality.
* 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 claim – and what information may be needed, next steps in processing, etc.
Academic And Additional Qualifications Needed
* Bachelor's degree in Nursing, Health Sciences, Insurance, or related field.
* Basic understanding of medical terminology and health insurance policies.
* Proficiency in Cantonese, Mandarin, and English (speak, read, and write).
* Familiarity with Hong Kong's healthcare system and insurance regulations.
* Strong attention to detail and data entry accuracy.
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 or @cognizant.
Seniority level
* Seniority level
Entry level
Employment type
* Employment type
Full-time
Job function
* Job function
Business Development and Sales
* Industries
IT Services and IT Consulting and Business Consulting and Services
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