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Major Group
3
Technicians and Associate Professionals
Sub-Major Group
33
Business and Administration Associate Professionals
Unit Group
3344
Medical Secretaries
Minor Unit Group
MASCO Code
3344-03
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Medical Insurance Assistant
Medical Insurance Assistant supports the processing and administration of medical insurance claims by applying knowledge of medical terminology and procedures. They review healthcare documentation, verify policy coverage, calculate reimbursements, and ensure claims are settled accurately and on time, while maintaining records and complying with insurance procedures. The role also involves liaising with clients and internal departments to facilitate the smooth operation of the claims process.
Tasks
Receive and review medical insurance claims from patients and healthcare providers.
Verify claim details against policy coverage and eligibility requirements.
Communicate and coordinate with healthcare providers, insurers, and policyholders regarding claim processing.
Calculate claim amounts according to insurance terms, coverage, and service tariffs.
Update and maintain records in claims management systems.
Process claim payments or issue notifications for claim denials with supporting reasons.
Complete insurance claim forms and related documentation accurately.
Maintain and organise insurance-related medical records, files, and reference materials.
Assist in preparing and managing policy documentation and administrative processes.
Prepare reports on claim trends, approvals, and rejections for monitoring purposes.
Skills
Basic
Attention to detail and high accuracy in data entry.
Basic computer literacy, including Microsoft Office.
Good written and verbal communication in widely used languages.
Organisational and time-management skills.
Service orientation and problem-solving skills.
Specific
Ability to interpret insurance policy documents and assess eligibility criteria.
Competency in claims adjudication procedures and requirements.
Knowledge in data protection regulations and confidentiality requirements in healthcare insurance.
Knowledge in healthcare and insurance terminology.
Knowledge in medical insurance claims processing and insurance workflow procedures.
Proficiency in insurance and claims management software systems.
Additional Info
QUALIFICATION
Diploma or equivalent
Related Courses
MASCO
Hi, I can assist you with questions related to the Malaysia Standard Classification of Occupations (MASCO).
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