Senior Process Executive – Pre-Authorization

Title: Advisor – Pre-Authorization

Location: Kuala Lumpur, Malaysia

Experience: 0-5 Years

Summary of the Role:

The Case Management Advisor is responsible for Pre-Authorization process from members & medical providers to ensure that medical treatments, procedures, or medications requiring prior approval are authorized. This role is critical in streamlining the healthcare process, ensuring timely patient care, and facilitating proper reimbursement while adhering to insurance policies and regulatory guidelines.

List of Duties:

• Review and assess pre-authorization (PA) requests from members or providers for completeness, accuracy, and eligibility in accordance with policy terms and conditions.
• Verify medical charges against appropriate diagnosis, procedure, and medical codes to ensure consistency and compliance.
• Communicate Pre-authorization results to members or providers within the service level agreements
• Request additional information or clarification from members or providers to support PA decisions
• Escalating complex or exceptional cases to senior advisors or supervisors as needed

Desired Professional Experience:

• With 0-5 years of experience in Pre-authorization or medical claims processing
• With Healthcare background is preferred
• With knowledge of medical terminology, billing codes (ICD 9, ICD 10, CPT) and medical insurance polices is preferred
• Good time management skill and ability to multitask
• Proficient in Cantonese, Mandarin, and English (speak, read, and write).

About Cognizant:

Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant.

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