Your everyday
- Daily monitoring of all medical claims.
- Manage the expectation of customers in line with Company’s direction
- Verifying claims documents vs policy terms & conditions to ensure genuineness of claim within policy coverage
- Coordinate between customers, service providers to ensure excellent service
- Coordinating with Accident & Health team for medical opinion and claim approval & ensure targeted turnaround time is achieved
- Performing medical contact to gather information from hospitals/medical center
- Explaining medical problems to patients or their families
- Reviewing the treatment provided by hospitals is relevant to the case and in appropriate price
- Flag irregular/fraudulent/exaggerated claims to superior for further action
- Liaising with hospitals with a view to eliminating unnecessary or irrelevant treatment, over-servicing, over-charging and cost-containment
- Evaluating customer’s condition and arranging proper assistance to claimant
- Handling e-mail & all communication channels within targeted timeline
- Prepare weekly reporting on TAT, outstanding & repudiated cases
- Any other task/responsibility assigned by superior
Your profile
- 1-2 years of nursing or nurse claim assessor experience.
- Experience working under the Insurance department in the hospital or insurance and broker will be a big plus.
- Have a flexible schedule and must be able to work in shifts which may include night schedule and weekend.
- Able to work in commercial environment and fast moving business
- Good interpersonal and communication skills
- Computer literacy is essential
- Self-motivated, result oriented, ability to work under pressure, creative and energetic
- Willing to learn and can do attitude