Roles & Responsibilities:

• Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company’s requirements and guidelines 

• Adjudicate medical claims by following the organization guidelines & within the assigned authority limit. 

• Establish covered medical insurance losses against benefits coverage and eligibility. 

• Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required). 

• Ensure confidentiality of all claims information, inclusive of claims guidelines and internal controls. 

• To identify Process improvement ideas & initiatives leading to greater operations effectiveness and efficiency. 

• Ensure claims are processed within the specified turnaround time 

• To performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements. 

Minimum Job Requirements:

• Bachelor’s degree or equivalent, in any field of study or with relevant background.
• Minimum of 5 years working experience preferably in the insurance or medical industry.
• Candidate with medical insurance/nursing/medical science/hospital background will be added advantage.
• Able to work in fast paced environment, independent, customer focused, result oriented & disciplined.
• Adaptable and able to work on own with minimal supervision.
• Ability to multi-task, plan effectively and meet deadlines.
• Service oriented/customers focus with sense of urgency and practice prioritization and critical thinking in jobs.
• Demonstrate good written and oral communication skills.
• Good knowledge of using Microsoft Office and others software applications especially reporting tools.
• Able to adapt in the face of constant changes in the organization.
• Good analytical, innovative and good in problem solving skill, ability to exercise judgment and take initiative to make decision and resolve problem(s).
• Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes. 
• Able to work on rotating shifts.
• Contract position available.