Medical Claims Specialist — Process, Resolve & Improve

RECRUIT EXPRESS PTE LTD; Singapore; On-site; SGD 40,000 - 70,000; Full time

Job summary

RECRUIT EXPRESS PTE LTD in Singapore is seeking a Claims Processor to assess and process medical insurance claims and appeals accurately, in line with established service standards. You will review medical documents and policy terms to determine claim eligibility and appropriate payouts.

The role involves managing investigations and appeals, liaising with policyholders, medical institutions and internal stakeholders, providing empathetic support to customers, and ensuring compliance with

Responsibilities

• Assess and process medical insurance claims and appeals accurately and 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 is seeking a Claims Processor to assess and process medical insurance claims and appeals accurately, in line with established service standards. You will review medical documents and policy terms to determine claim eligibility and appropriate payouts.

The role involves managing investigations and appeals, liaising with policyholders, medical institutions and internal stakeholders, providing empathetic support to customers, and ensuring compliance with