Role Summary:
The main responsibility of the Resolution & Investigation Intern is to assist in attending to and resolving queries, requests, and complaints over basic malpractices conducted by panel healthcare partners and to address and resolve discrepancies in the information displayed in panel-submitted claims by panel healthcare partners. In addition, the incumbent will be assigned to perform ad-hoc duties as per departmental agreed practice and terms. The incumbent is also required to attend to and perform manual amendments of panel-submitted claims as requested by panel healthcare partners or as per request by corporate clients with notification of the panel healthcare partners.

Job Description:

• To be an effective communicator and ensure all basic queries, requests and complaint cases related to panel healthcare issues raised by corporate clients are acknowledged in a timely manner and corporate clients are constantly informed throughout case handling.
• Attend to and provide resolution for queries, requests and complaint cases related to panel healthcare issues raised by corporate clients.
• Perform investigations for queries, requests and complaint cases related to panel healthcare issues raised by corporate clients i.e., panel malpractice and non-adherence to agreed HealthMetrics’ panel Standard Operating Procedures (SOPs) e.g., unjustifiable collect cash transaction, omission of timely panel check-ins and late claim submissions and discrepancy of information in panel submitted claims with actual scenarios.
• To contact corporate HR-in-charge and obtain final decision (approval or rejection) from corporate HR-in-charge for any amendment requests of information within panel-submitted claims that arise from panel healthcare partners.
• Manage the resolution of queries, requests and complaint cases related to panel healthcare issues raised by corporate clients within agreed stipulated service level agreement timeframe.
• Perform departmental duties i.e., processing of late claim submission requests by panel healthcare panels in Operations dashboard.
• Ensure that the Service Level Agreement (SLA) metrics of queries, requests and complaint cases related to panel healthcare issues raised by corporate clients are met.
• Execute other/any ad-hoc operational and administrative tasks as required by management from time to time.

Job Description:

• Possess at least SPM/Diploma in any field
• Able to work in a team
• Able to converse, read and write in English and Bahasa Malaysia fluently
• Able to use Microsoft Word and Microsoft Excel
• Must be available to work on rotational shifts including public holidays and weekends
• Customer orientation and ability to adapt/respond to different types of characters
• Excellent verbal and written communication skills
• Ability to multi-task, prioritize and manage time effectively
• Strong phone contact handling skills and active listening
• Ability to stay calm when customers are stressed or upset
• A positive attitude, energetic approach, and self-motivation are all essential