Claims Processing Specialist
3 days ago
About AIA
AIA Hong Kong and Macau is a leading insurance company dedicated to creating a healthier, more sustainable future for everyone. Our commitment to excellence has earned us numerous awards and accolades, but what really sets us apart is our passion for making a positive impact on the lives of our customers and communities.
We're on a mission to help a billion people live Healthier, Longer, Better Lives by 2030, and we need talented professionals like you to join us on this journey. If you're driven to make a difference and passionate about delivering exceptional results, then we want to hear from you.
Job Requirements
This role involves determining the validity and authorising settlement of individual health insurance claims. As a Medical Insurance Examiner, you will be responsible for ensuring quality audits are done for your team members, pre-certifying cases for issuance of guarantee letters, and assisting in the assignment and monitoring of all documents received in their respective team's queues.
Responsibilities:
- To support and lead a team of assessors in pre-certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company's requirements and guidelines.
- To ensure quality audits are done for the respective team members.
- To pre-certify cases for issuance of guarantee letter in compliance to Company's requirements and guidelines assist the team target productivity benchmark.
- To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
- To assist in the assignment and monitoring of all documents received in their respective team's queues.
- To assist WFM (workforce management) team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the guarantee letter process.
- To ensure huddles and communications are carried out as per the agreed frequency.
- To ensure coaching and engagement activities are carried out for performance improvement and cost containment.
- To ensure that cases of fee disputes are handled and resolved within targeted TAT.
- To ensure that error rate in guarantee letter issuance is less than the target.
Skills and Qualifications
To succeed in this role, you must have 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. You should also possess strong technical skills, including claims assessment, medical report knowledge, and health insurance policy knowledge.
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