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
Qualifications
Can speak and understand Chinese/Mandarin language
Excellent attention to detail, quality, and accuracy