This role is based in Hong Kong and offers a competitive salary in HKD. It is a critical position playing a vital role in delivering exceptional customer service throughout the in-patient care journey. The key purpose of the role is to ensure fair treatment of customers by assessing claims based on regional coding and billing practices while contributing towards the broader ambition to enhance in-house third-party administrator capabilities.
The successful candidate will be responsible for leading a regional in-patient team to manage 100% of day-case and inpatient cases, overseeing surgeon, anaesthesia and hospital fees. Strong expertise in evaluating medical information against clinical and policy guidelines using evidence-based practices is paramount. Claims assessment and ensuring provider payments align with pre-authorisation conditions will be central to this role, including negotiating with providers as needed to ensure contract compliance. Monitoring provider performance and escalating behavioural trends to improve market practices will also be required.
In addition, the candidate will be tasked with investigating and responding to enquiries regarding authorisations and claims from a range of stakeholders. Compliance with turnaround times and customer feedback will be essential for continuous improvement. The role requires an accurate interpretation of internal benefit policies, the use of appropriate coding systems, and the ability to handle complaints with professionalism and limited supervision. Further responsibilities include identifying cost-reduction opportunities, ensuring audit and compliance standards are met, presenting insights internally and externally, and detecting potential fraud or abuse.
Applicants should possess a bachelor’s degree or above, with either registered nurse experience (local or international) or at least one year of experience in utilisation review within insurance or TPA settings. An in-depth knowledge of coding systems and advanced proficiency in Microsoft Word and Excel are essential. Ideal candidates will demonstrate excellent interpersonal, analytical, and critical thinking skills, cultural awareness, strong communication abilities in English, and a commitment to delivering high-quality care and operational outcomes.
Familiarity with regulatory obligations, especially in relation to fair consumer outcomes, is a requirement, as is alignment with core capabilities such as advanced leadership, effective team collaboration, business acumen, and customer centricity.