Healthcare Claims Specialist: Efficient, Accurate Evaluations

FULLERTON HEALTHCARE GROUP PTE. LIMITED; Singapore; On-site; SGD 42,000 - 56,000; Full time

Job summary

FULLERTON HEALTHCARE GROUP PTE. LIMITED is seeking a skilled Claims Assessor in Singapore to evaluate inpatient and outpatient medical claims for group insurance policies.

You will review claims for accuracy, ensure adherence to policy terms, and handle CPF rejections with root-cause analysis. Daily processing, audits, and collaboration with providers and policyholders are essential to maintain service levels.

Qualifications

• Diploma or higher educational qualification.
• Strong knowledge of health insurance policies and claims processes.
• At least 1 year of experience in claims assessment.
• 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 and compliance.
• Ensure claims processing aligns with policy coverage and guidelines.
• Perform daily claims processing and checks to meet turnaround times.
• Analyze CPF rejections and identify root causes for corrective actions.
• Conduct weekly appeal audits to validate decisions and improve processes.
• Investigate complex cases and client complaints with timely resolutions.
• Liaise with healthcare providers, policyholders, and internal stakeholders for required information.
• Flag potentially fraudulent claims and escalate according to protocols.
• Document claims assessments, decisions, and audits for reporting and audits.

Skills

Health insurance knowledge

Claims assessment experience

Analytical skills

Medical terminology

Communication skills

Education

Diploma or higher

Job description

FULLERTON HEALTHCARE GROUP PTE. LIMITED is seeking a skilled Claims Assessor in Singapore to evaluate inpatient and outpatient medical claims for group insurance policies.

You will review claims for accuracy, ensure adherence to policy terms, and handle CPF rejections with root-cause analysis. Daily processing, audits, and collaboration with providers and policyholders are essential to maintain service levels.