Senior Process Executive – Cognizant Malaysia

The Senior Process Executive – Pre-Authorization is responsible for managing the pre-authorization process involving members and medical providers. This role ensures that medical treatments, procedures, or medications requiring prior approval are authorized in accordance with insurance policies and regulatory guidelines to facilitate timely patient care and reimbursement.

In this role, you will review and assess pre-authorization requests for completeness and accuracy while verifying medical charges against appropriate codes. You will communicate authorization results to relevant parties and escalate complex cases when necessary.

Key Responsibilities:

• Review pre-authorization requests for completeness and accuracy.
• Verify medical charges against appropriate billing codes.
• Communicate authorization results to members and medical providers.
• Escalate complex cases to senior management as needed.
• Maintain accurate records of pre-authorization requests and outcomes.
• Collaborate with healthcare professionals to ensure compliance with insurance policies.
• Provide excellent customer service to members and providers regarding pre-authorization inquiries.