This role reports directly to the Lead, Process Improvement and Transformation and will be working closely with PRUShield claims user on escalated issues to provide interim solution and support for the division.
The incumbent will work under the direction of the Lead, Process Improvement and Transformation, the individual will be the initial point of contact for claims users and will need to collaborate with each users directly on escalated issues. The individual will also be providing support to ensure systems information/data are updated on a timely manner. The role requires a close attention to detail and able to work closely with claims assessor.
Job Descriptions:
- Review all system related feedback/escalation, from claim assessors and servicing team.
- Work with tech team/Business Analyst to investigate on issue.
- Collaborate with tech team to identify interim solution and permanent solution.
- Raise Remedy Force ticket and monitor all outstanding tickets.
- Prepare necessary forms for table lifting and DFU.
- Monitor and track all open DFU/Table Lifting with proper record of all DFU performed by PRUShield claims team.
- Coordinate with claim assessors and tech teams on DFU process.
- Review and sign off when DFU is completed.
- Work with tech team on regular table lifting (daily)
- Review and ensure process is completed before providing sign off when table lifting is completed
- Maintain of data in LifeAsia/Jireh system - panel/non-panel/Extended panel list
- Ensure timely updates of data provided by MOH in system Clinics, Cancer Drug List, TOSP/ICD Codes
- Identify opportunities for the prevention of Fraud, Waste and Abuse (FWA) within Prushield Claims to control the financial and reputational risk
- Translate FWA business logics into system rules and work with the relevant stakeholders for the deployment of the rules in the production system
- Collaborate with the QA Tester to ensure and validate the accuracy of the test results in the UAT environment prior to the deployment in the production
