Position Objective:
Ensure claims are adjudicated accurately and in a timely manner by establishing the validity of loss through assessment of medical documentation & assembling additional information as required.
Roles and Responsibilities
- Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company's requirements and guidelines
- Establish covered medical insurance losses against benefits coverage and eligibility.
- Adjudicate medical claims by following the organization guidelines & within the assigned authority limit.
- Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required).
- Ensure confidentiality of all claims information, inclusive of claims guidelines and internal controls.
- Ensure claims are processed within the specified turnaround time
- To performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements.
- To adhere to 24/7 rotational shift working arrangements.
Minimum Job Requirements:
- Bachelor's degree or equivalent, in any field of study or with relevant background.
- Minimum of 3 years working experience preferably in the insurance or medical industry.
- Able to work in fast paced environment, independent, customer focused, result oriented & disciplined.
- Adaptable and able to work on own with minimal supervision.
- Service oriented/customers focus with sense of urgency and practice prioritization and critical thinking in jobs.
- Demonstrate good written and oral communication skills.
- Good knowledge of using Microsoft Office and others software applications especially reporting tools.
- Able to adapt in the face of constant changes in the organization.
- Good analytical, innovative and good in problem solving skill, ability to exercise judgment and take initiative to make decision and resolve problem(s).
- Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
- Able to work on rotating shifts.
- Candidate with medical insurance/nursing/medical science/hospital background will be added advantage.
- Ability to multi-task, plan effectively and meet deadlines.
