Everyday you will...

  • Daily monitoring of all medical claims.
  • Manage the expectation of customers in line with Company’s direction
  • Verifying claims documents vs policy terms & conditions to ensure genuineness of claim within policy coverage
  • Coordinate between customers, broker, service providers to ensure excellent service
  • Coordinating with Accident & Health team for medical opinion and claim approval & ensure targeted turnaround time is achieved
  • Performing medical contact to gather information from hospitals/medical center
  • Explaining medical problems to patients or their families
  • Reviewing the treatment provided by hospitals is relevant to the case and in appropriate price
  • Flag irregular/fraudulent/exaggerated claims to superior for further action
  • Liaising with hospitals with a view to eliminating unnecessary or irrelevant treatment, over-servicing, over-charging and cost-containment
  • Evaluating customer’s condition and arranging proper assistance to claimant
  • Handling e-mail & all communication channels within targeted timeline
  • Prepare weekly reporting on TAT, outstanding & repudiated cases
  • Any other task/responsibility assigned by superior


Qualifications:

  • 3-5 years of nursing or nurse claim assessor experience.
  • Experience working under the Insurance department in the hospital or insurance and broker will be a big plus.
  • Have a flexible schedule and must be able to work in shifts which may include night schedule and weekend.
  • Able to work in commercial environment and fast moving business
  • Good interpersonal and communication skills
  • Computer literacy is essential
  • Self-motivated, result oriented, ability to work under pressure, creative and energetic
  • Willing to learn and can do attitude