Bilingual Mandarin Analyst
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Summary
The Bilingual Mandarin Analyst reviews medical documentation and contractual language to determine claim eligibility and ensure accurate, timely processing. The role requires proficiency in Mandarin and strong analytical skills to manage claims while meeting strict service level agreements.
KEY RESPONSIBILITIES:
TO QUALIFY:
- 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
- Can speak and understand Chinese/Mandarin language
- Excellent attention to detail, quality, and accuracy
- Excellent organizational, workload, and time management skills
- Able to work within tight timeframes to achieve challenging objectives and TATs
- Must have the ability to work with a sense of urgency and be a self-starter with a customer-focused mindset
- Must be technically savvy with the ability to toggle between multiple applications and/or computer monitors simultaneously
- Proficient with MS Office applications (Word, Outlook)
- Strong written communication skills demonstrated in previous work experience
- Experience in effectively meeting/exceeding individual professional expectations and team goals
- Demonstrated analytical and basic math skills