苏州招聘

职位描述：
招聘说明：
1. 此岗位主要处理新加坡CLAIMS，需立即上岗（不能立即上岗者请勿投递）

Requirement:
1. Analyzes and approves Claims.
2. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
3. Coordinates responses for phone inquiries and written correspondence related to claim processing issues.
4. Routes and triages High $ claims and seeks support and advice from designated Specialists. (Senior Claim Benefits Specialist).
5. Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
6. Investigate claims for possible abuse and fraud.
7. May facilitate training when considered topic subject matter expert.
8. In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and all systems within specified turn-around-time parameters.
9. Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., use of all documented resources).
10. Escalate unresolved claims complaints and high costs claims to the claims supervisor for guidance.
11. Continually work to improve best practices procedures and standards.
12. Ensures compliance with requirements of regional compliance authority/industry regulator.
13. Adheres to international privacy policies, practices and procedures.
14. Exhibits behaviors outlined in Claim Benefit Specialist Competencies.

Experience:
1. 1-2 years’claim experience, travel claims experience is preferred.
2. Strong communication skills (verbal, written in Chinese & English).
3. Ability to work with cross-functional business units and vendors.
4. Critical thinking and decision making skills.
5. Advance skills in Microsoft office applications. 举报 分享

TransFingo has its origins as an Accounting Services firm serving small and medium enterprises in Singapore and the region. In 2003, TransFingo re-focused its business as a Business Process Outsourcing service provider with the addition of key management with vast industry experience in Process Risk Consulting and B2B technology solutions development.

TransFingo is a leading provider of Business Process Outsourcing (BPO) and Business Advisory Services in the Asia Pacific region. Our process teams support operations in 33 countries in the Asia Pacific region with multi-lingual capabilities.

Business Units

Business Process Outsourcing

We are in the business of enabling companies to be competitive by outsourcing their non-core business activities and focusing resources on their core competencies. TransFingo's knowledge of emerging business models and solutions enable us to provide our clients with the best possible Processes, Technologies and Talents.

We take PRIMARY RESPONSIBILITY for providing a business process or function. We go beyond managing the technology infrastructure and software applications by taking primary responsibility for ensuring that the process works, interfaces effectively with other company functions and delivering the outcomes intended.

The TransFingo BPO Solutions Suite provides services in the area of Finance & Accounting, Human Resources and Customer Relationship Management. TransFingo’s approach to BPO is modular where a client may first outsource to us processes with tactical value. Thereafter, TransFingo can further value-add by providing outsourcing services with more strategic value.

Risk Management Consulting
In Risk Management Consulting, TransFingo can work with you at an enterprise-wide level, or on individual functions and processes, to help you:

. Understand your risk capacity and tolerance, and recommend an effective framework and organizational structure for managing risk
. Assess business risks
. Formulate business risk management strategies
. Design and implement risk management solutions

With our database of best business, risk management and controls practices, we apply quantitative and qualitative diagnostic tools to benchmark your performance against world-class performers in business risk management.
Our approach is collaborative. We work with you to provide services in locations where you lack resources. We provide people with the skills and knowledge you lack, or train your people to give them the competencies you need. With our advanced risk assessment, control and monitoring methodologies, our extensive knowledge bases and our sophisticated enabling technologies, we help you to effectively integrate risk management into your processes and your organization.

Website: www.transfingo.com
地址:苏州工业园区金鸡湖大道1355号国际科技园D401
邮编:215021
Email: hr_cn@transfingo.com
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