Main?duties/Responsibilities?
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·???????You?save?all?necessary?information??regarding?the?Guarantee?of?Payment?/?Pre-authorization?request?in?an?internal??database.?
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·???????Work?with?medical?consultant??team?closely?on?medical?necessity?review,?especially?on?some?complex?cases,?meanwhile?ensuring??local?clinical?norms?are?taken?into?account.?
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·??????????You?are?responsible?for?the?timely?sending?of?all??Guarantees?of?Payments?together?with?your?colleagues
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·??????????Provide?guidance?and?support?to?customers?utilizing?the??expatriate?healthcare?plan
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·??????????Provide?payment?guarantees?as?required?to?customers,??clients?and?healthcare?providers?around?the?globe,?taking?into?account?local??clinical?and?cultural?norms?and?ensuring?a?proactive?approach?at?all?times
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·??????????Perform?prospective,?concurrent,?and?retrospective??reviews?for?inpatient?acute?care,?rehabilitation,?and?select?outpatient??services?utilizing?various?tools,?dependent?upon?the?location?of?treatment.??Liaise?with?appropriate?clinical?team(s)?as?required
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·??????????Establish?medical?necessity?by?evaluating?patient??treatment?plans?with?support?as?required?from?various?global?clinical?teams,??ensuring?local?clinical?norms?are?taken?into?account
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·??????????Investigate?reasonable?&?customary?costs?at?a?local??level,?using?a?variety?of?tools?and/or?contacts?with?our?global?partners?and??challenge?healthcare?providers?where?costs?are?excessive
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·??????????Identify?and?create?potential?savings?opportunities?as??appropriate?e.g.?encourage?utilization?of?network?providers;?negotiate??discounts?with?non-network?providers,?manage?length?of?stay?etc.
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·??????????Directly?negotiate?discounts?where?the?opportunity??exists,?taking?into?account?local?cultural?expectations?and?tailoring?your??approach?as?required
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·??????????Provide?guidance?and?support?to?customers?receiving??ongoing,?complex?and/or?high?cost?care.?Manage?own??caseload?and?coordinate?all?assigned?cases?to?add?value?for?the?customer
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·??????????Ensure?that?case?management?objectives?are?met?by??evaluating?the?effectiveness?of?alternative?care?services?and?that?cost??effective,?quality?care?is?maintained.?
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·??????????Communicate?regularly?and?proactively?with?customers,??providers?and?partners?regarding?treatment?plans?and?claims?costs
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·??????????Work??closely?within?the?team?staff,?including?medical?consultant,?case?manager?and??team?leader?on?the?comprehensive?and?potential?appeal?cases,?support?case??associate?if?any?needs
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·??????????Maintain?accurate?records?and?files?as?required?
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·??????????Achievement?of?set?individual?targets?that?contribute?to??the?overall?performance?of?the?team
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·??????????Identify?potential?process?improvements?and?make??recommendations?to?unit?manager?
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·??????????Carry??out?other?adhoc?tasks?as?required?to?meet?business?needs
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·??????????Attending??the?internal?medical?training?/?meeting?as?per?request?/?schedule
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Requirement
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·??????????Bachelor?degree,?nurse?background?or?experience?in??hospital?or?similar?industry/?role?is?preferred?
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·??????????2-3?years’?experience?in?a?customer?service?or?claims??environment?is?preferred?but?not?a?must.?Fresh?graduates?are?welcome?to?apply.?
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·??????????Customer-focused,??action-orientated?problem-solving?skills.
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·??????????Strong?research?and?analytical?skills
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·??????????Ability?to?exercise?independent?judgment?in??decision?making,?utilizing?all?relevant?information
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·??????????Ability?to?assess?complex?issues,?recommend??changes?and?resolve?problems
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·??????????Effective?influencing?and?negotiation?skills
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·??????????Excellent?interpersonal?skills?
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·??????????Good?verbal?and?written?communication?skills
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·??????????Ability?to?organise,?prioritise?and?manage?workflow?
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·??????????System?navigation?and?Microsoft?application?skills?
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·??????????Regulatory?awareness?
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·??????????Self-motivated?with?confidence?to?use?own?initiative?and??to?innovate.
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·??????????Stress?resistant?and?efficient,?finding?a?good?balance??between?quality?and?quantity
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·??????????Fluency?in?Mandarin?and?English,?Fluency?in?Japanese?is??preferred.