Employee Benefit Cashless Claim, Analyst

AIA Shared Services; Kuala Lumpur; Hybrid; MYR 60,000 - 90,000; Full time

Job summary

AIA Shared Services in Malaysia is seeking a role responsible for determining the validity and authorising settlement of group health insurance claims. You will pre-certify documents and adjudicate medical claims in line with guidelines and within your authority limits.

You will establish losses against benefits coverage, gather medical documentation, and escalate questionable claims. Confidentiality and timely processing are essential; a bachelor’s degree and 5+ years in insurance/medical

Qualifications

• Bachelor’s degree or equivalent required.
• Minimum 5 years experience in insurance/medical industry.
• Medical insurance/nursing/medical science background is a plus.
• Able to work in fast-paced environment with minimal supervision.
• Strong written and verbal communication.

Responsibilities

• Ensure completeness of Claims / Guarantee Letter.
• Pre-certify documents in compliance with requirements and guidelines.
• Adjudicate medical claims within assigned authority.
• Establish covered losses against benefits coverage and eligibility.
• Gather information from claimant history, physicians, employers, hospital details, medications, procedures.
• Escalate questionable claims to supervisor or medical advisory officers.
• Maintain confidentiality of all claims information and guidelines.
• Identify process improvement ideas to enhance efficiency.
• Ensure claims are processed within turnaround time.
• Perform other duties as assigned by supervisor.

Skills

Attention to detail

Communication skills

Analytical thinking

Time management

Education

Bachelor’s degree or equivalent

5+ years Insurance/medical industry experience

Medical/nursing background advantageous

Tools

Microsoft Office

Reporting tools

Job description

About the Role

Responsible for determining the validity and authorising settlement of group health insurance claims

Roles & Responsibilities:

• 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.
• To identify Process improvement ideas & initiatives leading to greater operations effectiveness and efficiency..
• 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:

• 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.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

Better starts with people who reimagine what is possible and turn ideas into meaningful action. At AIA, you will contribute in your own way, help shape outcomes that matter and collaborate with colleagues across disciplines, teams, markets and levels. We will support you to broaden your perspective, strengthen your capabilities and grow your impact. Together, we challenge assumptions, learn from one another and find better ways forward. Bring your ambition, experience and ideas to AIA, and help shape what “better” looks like.