Individual Benefit Cashless Claim, Analyst

AIA Malaysia; Kuala Lumpur; On-site; MYR 60,000 - 90,000; Full time

Job summary

A leading health insurance provider in Kuala Lumpur seeks a Claims Assessment Officer to manage the validation and settlement of health insurance claims. You will lead a team, ensure compliance with guidelines, and handle claim disputes. The ideal candidate will have a Bachelor's degree in a medical field and at least 2 years of experience. Proficiency in English and Bahasa Malaysia is required. This role offers growth opportunities in a supportive environment.

Qualifications

• Minimum 2 years of experience in health insurance claims.
• Proficient in English and Bahasa Malaysia.
• Knowledge of health insurance policies and coverage is required.

Responsibilities

• Lead a team of assessors in health insurance claims.
• Ensure quality audits and compliance with guidelines.
• Handle fee disputes and improve performance metrics.
• Ensure guarantee letters are issued accurately within target turnaround times and with proper authority.
• Assist in managing documents received in team queues and monitor workflow.
• Support WFM in maintaining adequate headcount to cover GL processes on a monthly basis.
• Facilitate huddles and communications as per schedule.
• Coach and engage the team for performance improvement and cost containment.
• Handle fee dispute cases and ensure resolution within target times.
• Monitor error rates in GL issuance to stay under targets.
• Perform other duties as assigned to meet operational requirements.

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.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.