Senior Claims Examiner, A&H Claims

Job description

Key Objective The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.

Key Accountabilities & Responsibilities

Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis. Auditing cashless claims for Group and Individual hospitalisation and surgical claims. Overseeing and facilitating payment processing for bordereaux medical claims. Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements. To monitor the performance of the appointed TPA and be proactive on liaising with TPA on resolving issues.

Keeping constant communication with management and underwriting teams. Providing feedback on any visible claims trends. Monthly/Quarterly/Yearly review of aging files. Participate in Ad Hoc projects or tasks as assigned by supervisors.

Qualifications

Experience in handling medical related claims. Have sound knowledge on both medical and claims practices. Able to read and interpret medical reports. Strong attention to detail and accuracy in data entry, and document management. Critical thinking in evaluating authenticity of claims. Familiarity with Microsoft Office Suite (Word, Excel, Outlook). Effective communication skills, both written and verbal. Proactive and have strong work ethics.

Willingness to learn and adapting to new processes and regulatory requirements. Ability to work collaboratively in a team environment and support multiple tasks. Professional attitude and discretion when handling confidential information.