Employee Benefits Claims Management, Analyst

2 weeks ago

Kuala Lumpur, Kuala Lumpur, Malaysia AIA Malaysia Full time 30,000 - 60,000 per year

Position Objective:

Ensure claims are adjudicated accurately and in a timely manner by establishing the validity of loss through assessment of medical documentation & assembling additional information as required.

Roles and Responsibilities

  • Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company's requirements and guidelines
  • Establish covered medical insurance losses against benefits coverage and eligibility.
  • Adjudicate medical claims by following the organization guidelines & within the assigned authority limit.
  • 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.
  • To adhere to 24/7 rotational shift working arrangements.

Minimum Job Requirements:

  • Bachelor's degree or equivalent, in any field of study or with relevant background.
  • Minimum of 5 years working experience preferably in the insurance or medical industry.
  • Candidate with medical insurance/nursing/medical science/hospital background will be added advantage.
  • Able to work in fast paced environment, independent, customer focused, result oriented & disciplined.
  • Adaptable and able to work on own with minimal supervision.
  • Ability to multi-task, plan effectively and meet deadlines.
  • Service oriented/customers focus with sense of urgency and practice prioritization and critical thinking in jobs.
  • Demonstrate good written and oral communication skills.
  • Good knowledge of using Microsoft Office and others software applications especially reporting tools.
  • Able to adapt in the face of constant changes in the organization.
  • Good analytical, innovative and good in problem solving skill, ability to exercise judgment and take initiative to make decision and resolve problem(s).
  • Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
  • Able to work on rotating shifts.

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