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Healthcare Specialist



Technical Skills

  • Bill Payment
  • Claims
  • CMS
  • Compliance
  • Customer Service
  • Filing
  • Negotiation
  • Training

Job Description

HealthCare Specialist

Location: Hong Kong, HK

Job Summary

Contribute to the team by handling pre-approval request, answering enquiries from members and service providers, providing health advice and recruiting medical providers and monitoring its services standards to ensuring compliance to company’s policy and requirements.

Job Responsibilities

Pre-approval & Hotline Operations

Process pre-approval requests in accordance with the terms and conditions of the policy and the authority level with the turnaround time

  • Check eligibility of the member for benefit entitlement
  • Issues Letter of Guarantee whenever required
  • Approves Pre-approval with agreed fee and negotiates with the service providers to follow the logic of agreed fee
  • Provide case management and approve pre-approval under the technical direction of Medical Officer
  • Resolve both operation and servicing issues encountered and monitor the performance of Pre-approval team in OSS
  • Handle Non-Network pre-approval duties whenever required
  • Coordinate with Hotline Service & Ambassador Team and Non-Network Pre-approval team to ensure smooth operation
  • Provide training to Hotline Service & Ambassador Team and Non-Network Pre-approval team

Hotline Duties

Manage the Provider Pre-approval hotline and Nurse Line to provide excellent customer services

  • Respond to questions and problems from members and service providers regarding the interpretation and application of procedures concerning member care
  • Review non-office hours hotlines call log and follow up Pre-approval process
  • Provide Health advice
  • Answer enquiries of CEO LOG credit limit extension

Healthcare initiatives and company strategic projects

  • Review existing end-to-end Pre-approval process and streamline as necessary in order to ensure consistency, accuracy of the output and excellent customer experience
  • Review and improve workflow and system capabilities for efficient delivery of health services to clients and system interface with business partners
  • Review system for enhancement for efficiency and convenience for customers

Manage provider network

  • Review panel EDI files to ensure accurate billing and prepare monthly performance report with reference to CMS report
  • Assist Provider Management Team in initiating and maintaining network provider for health services including 1) establish working procedure and identify control process for compliance to ensure service standards and 2) accomplish the requirement for panel network on the submission of pre-approval request and EDI claims submission for accuracy and efficiency.

Other duties and responsibilities

  • Being the Champion for staff engagement program
  • Other duties and responsibilities as assigned by supervisor

Job Requirements

  • University / College graduate in Nursing / Health Administration or relevant disciplines
  • Registered nurse is highly preferred
  • Knowledge of current care delivery system
  • 2-3 years' practical clinical and specialty experience
  • Computer literacy
  • Strong interpersonal, communication and analytical skills
  • Good team player and customer focused
  • Self-motivated, willing to take on challenges and able to work under pressure

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

All personal information provided by applicant will be treated in strict confidence and used solely for recruitment purposes.  The personal information will be used strictly in accordance with AIA’s personal data policies, a copy of which will be provided upon request.  It is possible that information about the applicant or the applicant’s application will be shared with AIA and its related companies.  AIA will retain all applications for a period of up to 24 months after which the documents will be destroyed.

Employment TypeFull-time
Education LevelBachelor
QualificationAIA Professional Accountancy Qualification
AIA Group LimitedInsurance and Reinsurance

AIA Central, 1 Connaught Rd Central, Central

directions_walk13 mins walk from Admiralty Station