Job Description
Key Objective
The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.
Key Accountabilities & Responsibilities
- Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis.
- Auditing cashless claims for Group and Individual hospitalisation and surgical claims.
- Overseeing and facilitating payment processing for bordereaux medical claims.
- Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements.
- To monitor the performance of the appointed TPA and be proactive on liaising with TPA on resolving issues.
- Keeping constant communication with management and underwriting teams.
- Providing feedback on any visible claims trends.
- Monthly/Quarterly/Yearly review of aging files.
- Participate in Ad Hoc projects or tasks as assigned by supervisors.
Qualifications
- Experience in handling medical related claims.
- Have sound knowledge on both medical and claims practices.
- Able to read and interpret medical reports.
- Strong attention to detail and accuracy in data entry, and document management.
- Critical thinking in evaluating authenticity of claims.
- Familiarity with Microsoft Office Suite (Word, Excel, Outlook).
- Effective communication skills, both written and verbal.
- Proactive and have strong work ethics.
- Willingness to learn and adapting to new processes and regulatory requirements.
- Ability to work collaboratively in a team environment and support multiple tasks.
- Professional attitude and discretion when handling confidential information.
