Claims Executive (Employee Medical Benefits, Claims Management)

Responsibilities:

• Claims Assessment and Adjudication.
• Assessment of Outpatient and Inpatient claims with accuracy and within SLA
• Prompt handling of claims as well as Letter of Guarantee (LoG) enquiries and escalations at client’s premises
• Ensuring emails enquiries are well-managed and respond in a timely manner.
• Ensuring claim is assessed correctly in accordance with policy contract and guideline and approved within Authority Limit given.
• Ensuring claim settlement is concluded within the agreed Turnaround Time (TAT).
• Continuous communication with both internal and external customer and providing the required support with the objective of providing quality claim service experience.
• Assist to provide necessary information and ad-hoc assignment to Manager to allow for accurate and timely submission of reports to management.
• Investigate and escalate technical claim issue as and when experienced.
• To initiate improvement of process, workflows, or system on a continuous basis

Requirements:

• Possess at least a Diploma in any discipline.
• Minimum of 2 years of related work experience in the insurance industry, preferably experience with handling medical claims.
• Proficient in Microsoft Office
• Good analytical skills, meticulous with a flair for numbers to handle complex computations
• Excellent verbal and written communication skills and interpersonal skills.
• Able to work independently, able to grasp processes and system quickly.
• Able to multi-task and work under pressure to meet tight deadlines in a face-paced environment.
• Strong customer orientation, team player.
• Insurance Certifications such as Certified in Health Insurance (HI), Basic Insurance Concepts and Principles (BCP), Personal General Insurance (PGI) are preferred