Responsibility
- Provide accurate and timely assessment of Accident & Health insurance claims within prescribed turnaround time
- Evaluate and negotiate the resolution of claims, while mitigating damages to achieve cost-effective claim outcomes
- Obtain reserving, settlement and payment authority in accordance with authority level within applicable Service Level Agreement
- Determine settlement amount and resolve claims settlement disputes using various mechanism such as arbitration and mediation (if any)
- Manage appeal process for rejected claims
- Detect potential fraudulent claims in line with organization policies and procedures
- Manage customer communications on claims matter
- Liaise with third party service providers and resolve issues in connection with claims processes and procedures
- Conduct regular file review
- Exercise good claims management to achieve a desired claims result
Requirement
- At least Diploma and above
- Possess Certificate in General Insurance and Health Insurance certificate
- At least 1 year of claims assessment experience
- At least 5 years of claims assessment experience ( for Senior Executive)
- Qualifications in Medical related courses or Experience in handling Medical Claims will be an added advantage
- Good communication, problem-solving, analytical and negotiation skills
- Team Player
