Individual Claims Management, Analyst

1 week ago

Kuala Lumpur, Malaysia AIA Full time

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.
- It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030._
- And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business._

Sound like you? Then read on.

About the Role

Responsible for performing pre-certification; prospective, concurrent and retrospective review of hospitalization; and to ensure that cost containment measures are carried out without compromising on the care quality and service standards.

Roles and 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 team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the GL 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 GL issuance is less that the target.
- To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements.
- Education: Bachelor's Degree in Medicine or medical fields
- Years of Experience: Minimum 2 years of experience
- 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
- Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives._

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