Job ref no.: CT3116513-01#0148

Health Services Specialist


Handles customers' / agents' / medical partners' enquiries and complaints regarding all activities in insurance operation process (Medical Panel Service) through face to face interaction at hospital locations.

Job Responsibilities
Enquiry Operation
Handles customers' / agents' enquiries and complaints regarding all activities in medical insurance policy operation process such as Prior Authorization (PA) Approval, Letter of Guarantee (LOG) Medical Service booking and advice, Claims and In / Outpatient arrangement;
Reports problems, potential crisis and complainst to Manager for service improvement;
Follows through with agents / customers on servicing issues;

Prior Authorization (PA) / LOG Approval
Processes Prior Authorization requests in accordance with the terms and conditions of the policy and the authority level with the benchmark of pre-defined turnaround time
Checks eligibility of the member for benefit entitlement;
Explains benefit details and delivers claims / PA decision to customer if required;
Issues Letter of Guarantee whenever required;

Administrative Works
PA, LOG process;
Documentation / Service log or email to AIAHK Business Partners;

Other responsibilities
Conduct agency visits to different panel private hospitals / satelline clinics
Performs other responsibilities and duties periodically assigned by Manager in order to meet operational and / or other requirements.

Job Requirements
University graduate preferably with medical background
Familiar with Claims and PA procedures
2-3 years’ practical network management experience will be an advantage
Computer literacy
Cantonese and English speaking. Excellent verbal and written communication skills
Customer centric mindset with excellent customer service and complaint handling skills

We offer an attractive remuneration package to the successful candidate. Please submit your application by clicking Apply Now for our processing.

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More job information
Job ref no. CT3116513-01#0148
  • N/A
Job Function
  • 2 years - 7 years
Career Level
  • Entry level
  • Degree