Employee Benefit Cashless Claim, Analyst

AIA Malaysia; Kuala Lumpur; Sur place; MYR 48 000 - 72 000; Plein temps

Résumé du poste

AIA Malaysia is seeking a Claims Adjudicator for group health insurance claims. You will be responsible for validating and authorising settlements, ensuring completeness of documentation, and applying policy guidelines.

The role requires strong communication and attention to detail, with experience in the insurance/medical field. The candidate should be able to work in a fast-paced environment, manage multiple tasks, and handle rotating shifts while maintaining confidentiality of all claims

Qualifications

• Bachelor’s degree or equivalent in any field
• Minimum 5 years experience in insurance or medical industry
• Medical insurance/nursing/medical science background is a plus
• Able to work in a fast-paced environment, independent, customer-focused, result oriented and disciplined
• Able to multi-task, plan effectively and meet deadlines
• Excellent written and oral communication skills
• Able to work on rotating shifts

Responsabilités

• Ensure completeness of Claims / Guarantee Letter; pre-certify documents per requirements
• Adjudicate medical claims following guidelines within authority limit
• Establish covered medical losses against benefits coverage and eligibility
• Collect medical documentation from claimant history, physician, employer, hospital, etc.; escalate questionable claims
• Maintain confidentiality of all claims information and guidelines
• Identify process improvement ideas to enhance operations efficiency
• Ensure claims are processed within the specified turnaround time
• Perform other duties as assigned by supervisor

Connaissances

Claims processing

Communication skills

Time management

Analytical thinking

Customer focus

Formation

Bachelor’s degree or equivalent

Outils

Microsoft Office

Description du poste

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 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.