Medical Claims & Appeals Specialist — Process Improvement

RECRUIT EXPRESS PTE LTD; Singapore; On-site; SGD 36,000 - 58,000; Full time

Job summary

RECRUIT EXPRESS PTE LTD in Singapore seeks a diligent Claims Analyst to assess and process medical insurance claims and appeals according to service standards. You will review documentation, determine eligibility and payouts, manage investigations and ensure timely resolutions while maintaining compliance.

The role involves collaboration with policyholders, medical institutions and internal teams, driving process improvements and delivering excellent customer support.

Responsibilities

• Assess and process medical insurance claims and appeals accurately within established service standards.
• Review medical documents, policy terms and claim information to determine claim eligibility and appropriate payouts.
• Manage claim investigations, pending claims and appeals, ensuring timely resolution and adequate claim reserves.
• Identify unusual claim patterns, potential risks and areas for improvement in claims processes and controls.
• Liaise with policyholders, medical institutions, intermediaries and internal stakeholders to clarify medical information and outstanding requirements.
• Provide professional and empathetic support to customers throughout the claims process.
• Ensure claims decisions and processes comply with company policies, regulatory requirements and internal controls.
• Monitor industry and regulatory developments and highlight potential compliance or operational risks.
• Contribute to process improvement initiatives and service excellence projects.
• Perform other duties and projects as assigned by management.

Job description

RECRUIT EXPRESS PTE LTD in Singapore seeks a diligent Claims Analyst to assess and process medical insurance claims and appeals according to service standards. You will review documentation, determine eligibility and payouts, manage investigations and ensure timely resolutions while maintaining compliance.

The role involves collaboration with policyholders, medical institutions and internal teams, driving process improvements and delivering excellent customer support.