Employee Benefits Claims Management, Analyst
AIA
- Kuala Lumpur
- Permanent
- Full-time
- Ensure completeness of claims documents as per internal guideline.
- 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).
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or denial letter.
- Ensure claims are processed within the specified turnaround time
- Ensure confidentiality of all claim's information, inclusive of claims guidelines and internal controls.
- Maintains quality customer services by following customer service practices, responding to customer inquiries.
- Accomplish organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to contribute to the organization.
- Meeting individual efficiency target.
- Meeting individual quality target.
- Quality checks must be performed for every claim to ensure claims are processed and paid accurately based on benefits coverage.
- Improvement of efficiency and effectiveness of functional areas
- Ensure compliance to organization’s policies, procedures, guidelines, as well as state and federal insurance regulations.
- Bachelor’s degree or equivalent, in any field of study or with relevant background.
- Fresh Graduate are welcome to apply
- 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 direction.
- Ability to multi-task, plan optimally 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.