Job Description

• Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
• Assess medical appropriateness of claims submitted, and adjust claims as needed
• Pay all covered claims accurately and timely
• Execute on all client and provider SLA agreements
• Attain individual and team quality and productivity targets
• Manage both new claims and open claims equality and maintains decision turnaround times (TAT)
• Understand account Operations and Corporate Compliance, Polices and Procedures and best practices
• Stay abreast of ongoing trainings associated with role and business unit objectives

• Can speak and understand Chinese/Mandarin language
• Excellent attention to detail, quality, and accuracy
• Excellent organizational, workload, and time management skills
• Able to work within tight timeframes to achieve challenging objectives and TATs
• Must have the ability to work with a sense of urgency and be a self-starter with a customer-focused mindset
• Must be technically savvy with the ability to toggle between multiple applications and/or computer monitors simultaneously
• Proficient with MS Office applications (Word, Outlook)
• Strong written communication skills demonstrated in previous work experience
• Experience in effectively meeting/exceeding individual professional expectations and team goals
• Demonstrated analytical and basic math skills