Healthcare Claims Analyst: Precision & Impact

Fullerton Healthcare Group Pte Ltd; Singapore; On-site; SGD 42,000 - 66,000; Full time

Job summary

Fullerton Healthcare Group Pte Ltd in Singapore is seeking a Claims Assessor to evaluate medical claims for group policies. You will review inpatient and outpatient claims for accuracy, compliance, and timely settlement while upholding confidentiality and service standards.

The role requires a diploma or higher, knowledge of health insurance policies, and at least 1 year of claims experience. You will analyse rejections, perform daily checks, conduct weekly audits, and liaise with providers and

Qualifications

• Diploma or higher educational qualification.
• Strong knowledge of health insurance policies and claims processes.
• At least 1 year of experience in claims assessment, preferably in health or insurance setting.
• Ability to interpret medical reports and understand medical terminology.
• Excellent analytical and decision-making skills.
• Meticulous and high accuracy in claims processing.
• Good communication skills, both written and verbal.

Responsibilities

• Review inpatient and outpatient claims for accuracy, completeness, and policy compliance.
• Ensure claims are processed in accordance with policy coverage, terms, and guidelines.
• Carry out daily claims processing and checks to ensure timely settlements.
• Analyse CPF rejections, identify root causes, and implement corrective actions.
• Perform daily second-level checks to maintain quality and compliance.
• Conduct weekly appeal audits to validate decisions and improve processes.
• Investigate complex cases and client complaints, providing timely resolutions.
• Liaise with healthcare providers, policyholders, and internal stakeholders for information.
• Identify and flag potentially fraudulent claims or irregular patterns.
• Collaborate with team to improve processes and support quality initiatives.
• Maintain documentation of assessments, decisions, audits, and reviews.

Skills

Analytical thinking

Medical terminology

Communication skills

Policy knowledge

Attention to detail

Decision making

Education

Diploma or higher

Job description

Fullerton Healthcare Group Pte Ltd in Singapore is seeking a Claims Assessor to evaluate medical claims for group policies. You will review inpatient and outpatient claims for accuracy, compliance, and timely settlement while upholding confidentiality and service standards.

The role requires a diploma or higher, knowledge of health insurance policies, and at least 1 year of claims experience. You will analyse rejections, perform daily checks, conduct weekly audits, and liaise with providers and