Responsibilities:
- Claims Assessment and Adjudication.
- Assessment of Outpatient claims in accordance with policy contract and guidelines.
- Ensuring emails enquiries are well-managed and respond in a timely manner.
- Ensuring claim is assessed correctly in accordance with policy contract and guideline and approved within Authority Limit given.
- Ensuring claim settlement is concluded within the agreed Turnaround Time (TAT).
- Continuous communication with both internal and external customer and providing the required support with the objective of providing quality claim service experience.
- Assist to provide necessary information and ad-hoc assignment to Manager to allow for accurate and timely submission of reports to management.
- Investigate and escalate technical claim issue as and when experienced.
- To initiate improvement of process, workflows, or system on a continuous basis
Requirements:
- Possess at least a Diploma in any discipline.
- Minimum of 2 years of related work experience in the insurance industry, preferably experience with handling medical claims. (without prior experience will also be considered)
- Proficient in Microsoft Office
- Good analytical skills, meticulous with a flair for numbers to handle complex computations
- Excellent verbal and written communication skills and interpersonal skills.
- Able to work independently, able to grasp processes and system quickly.
- Able to multi-task and work under pressure to meet tight deadlines in a face-paced environment.
- Strong customer orientation, team player.
- Insurance Certifications such as Certified in Health Insurance (HI), Basic Insurance Concepts and Principles (BCP), Personal General Insurance (PGI) are preferred
