Employee Benefits Claims Management, Analyst

Found in: Talent MY C2 - 2 weeks ago


Kuala Lumpur, Malaysia AIA Full time

Description

: Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company’s requirements and guidelines Adjudicate medical claims by following the organization guidelines & within the assigned authority limit. Establish covered medical insurance losses against benefits coverage and eligibility. 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.

Minimum Job Requirements:

Candidate must possess at least a Bachelor's Degree, Post Graduate Diploma, Professional Degree or Master's Degree in Dentistry, Medicine, Medical Science, Biomedical, Nursing, Pharmacy, Pharmacology, Physiotherapy or equivalent. Candidate with claim experience is an added advantage. Fresh Graduate with medical background is encouraged to apply. Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge. Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs. Language: English and Bahasa Malaysia.
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