Insurance Claims Specialist: Precision, Resolution & Impact

Recruit Express Pte Ltd; Singapore; On-site; SGD 3,000 - 5,400; Full time

Job summary

Recruit Express Pte Ltd is seeking a claims assessor to review and approve medical and non-medical claims within policy terms, coordinate with providers and policyholders, and manage follow-ups on bank transfers, CPF issues, and refunds. The role includes preparing settlement letters, maintaining Statements of Accounts, and generating daily claims reports.

You will engage with clinics and intermediaries to resolve billing questions, support monthly receivables, and participate in system

Responsibilities

• Review and assess local and overseas medical and non-medical claims within policy terms and conditions and claims authority limit within stipulated turnaround time.
• Review and approve Pre-Authorisation/LOG requests within policy terms and conditions and MOH benchmark.
• Coordinate with medical providers, policyholders, and other stakeholders for additional information when necessary.
• Handle follow-ups on claims with unsuccessful bank transfers and CPF failures, such as voiding claims, creating refund entry and reprocessing of claims.
• Request and follow-up on the creation of insured members and medical service providers for affected claims.
• Prepare claim settlement letters and scan claims documents to shared drive.
• Update Statements of Accounts relating to hospital bills/claim settlements.
• Communicating with policy holders, healthcare providers, intermediaries and internal teams to resolve issues and clarify claim details.
• Address claim disputes or queries from clients or intermediaries in a professional and efficient manner.
• Following up with clinics/ hospital for enquiries on billing details.
• Following up on monthly outstanding receivables, including but not limited to requesting refund for overpayments from relevant parties such as claimants, hospitals, insurers and CPF Board.
• Prepare meeting minutes and reports, including but not limited to daily claims report, statistical analysis and trends.
• Handle finance and payment activities including but not limited to voiding claims, creating refund entries, raising and approving receipt voucher cancellations and cheque cancellations.
• Participate in projects and enhancement in claims system improvement including but not limited to data collection, UAT testing and suggest improvements to the claims assessment process to increase efficiency and accuracy.
• Identify potential fraud or inconsistencies and report them to management.
• Other assigned tasks

Job description

Recruit Express Pte Ltd is seeking a claims assessor to review and approve medical and non-medical claims within policy terms, coordinate with providers and policyholders, and manage follow-ups on bank transfers, CPF issues, and refunds. The role includes preparing settlement letters, maintaining Statements of Accounts, and generating daily claims reports.

You will engage with clinics and intermediaries to resolve billing questions, support monthly receivables, and participate in system