Individual Benefit Cashless Claim, Analyst

AIA Shared Services; Kuala Lumpur; Hybrid; MYR 72,000 - 110,000; Full time

Job summary

AIA Shared Services in Kuala Lumpur is seeking a Claims Assessments Lead to determine validity and authorize settlement of individual health insurance claims. You will lead a team of assessors in pre-certification, hospitalization, and case management, ensuring adherence to guidelines and timely production.

The role requires a degree in medicine, at least 2 years in health insurance, and strong knowledge of medical reports and policy terms.

Qualifications

• Bachelor's degree in medicine or medical fields.
• Minimum 2 years of experience in health insurance or related field.
• Knowledge of health insurance policy terms and claims assessment.

Responsibilities

• Lead a team of assessors in pre-certification and hospitalization case management.
• Conduct quality audits and ensure timely processing of guarantee letters.
• Pre-certify cases for guarantee letters in line with guidelines.
• Coordinate with WFM for headcount and shift planning for GL process.
• Coach and engage the team for performance improvement and cost containment.
• Handle fee disputes and reduce errors in GL issuance.

Skills

Claims assessment

Medical report knowledge

Health Insurance Policy knowledge

Education

Bachelor's degree in medicine or medical fields

Job description

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 individual health insurance claims.

Roles & Responsibilities

• To support and lead a team of assessors in pre-certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company’s requirements and guidelines.
• To ensure quality audits are done for the respective team members.
• To pre-certify cases for issuance of guarantee letter in compliance to Company’s requirements and guidelines assist the team target productivity benchmark.
• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
• To assist in the assignment and monitoring of all documents received in their respective team’s queues.
• To assist WFM team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the GL process.
• To ensure huddles and communications are carried out as per the agreed frequency.
• To ensure coaching and engagement activities are carried out for performance improvement and cost containment.
• To ensure that cases of fee disputes are handled and resolved within targeted TAT.
• To ensure that error rate in GL issuance is less that the target.
• To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements.

Minimum Job Requirements

• Education: Bachelor's degree in medicine or medical fields
• Years of Experience: Minimum 2 years of experience
• Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge
• Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs
• Language: English and Bahasa Malaysia

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.