Employee Benefits Claims Management, Analyst

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

Job summary

AIA Shared Services in Kuala Lumpur is seeking a qualified professional to adjudicate claims, verify medical documentation and assemble information for timely loss assessment and payment. You will pre-certify documents, ensure policy coverage and compliance with guidelines while maintaining strict confidentiality.

Ideal candidates have 5+ years in the insurance/medical sector, strong communication, analytical skills and the ability to multi-task in a fast-paced environment with minimal

Qualifications

• 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.

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.

Skills

Communication skills

Multitasking

Adaptability

Analytical thinking

Education

Bachelor’s degree or equivalent

Tools

Microsoft Office

Reporting tools

Job description

About the Role

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 & 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. Contract position available.

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

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