Job Summary
Analyze all type of claims (Death, Hospitalization, Outpatient, Dental, Maternity) include to support claim investigation or confirmation on claim cases.
Job Description:
- Review insurance claims filed by policyholders to ensure they are accurate and complete, that the individual understands their benefits, and that the policies cover the claims.
- Analyze and verify claim within agreed TAT.
- Make decision claim payment within authority limit.
- Investigate suspicious claim by letter and phone to hospital or clinic.
- Handle the queries and complaint from related parties, policy holder, agent/seller, call center, Third Party Administrators.
- Confirm medical claim cases from Third Party Administrators outside working hours.
- Assist other Departments (underwriting and credit life) in checking a customer's medical history and assisting with medical consultations for potential new customers.
- Assist in checking decision letters to customers (both pending and rejecting notes) and checking detailed payment tables to customers.
Requirements:
- Degree in Medical major.
- Minimum 5-year experience in claim analyst reimbursement in life insurance
- Having network in local claim community
- Expert in SQL, Microsoft Excel, data visualization and dashboarding.
- Good communication skills both verbally and in writing required.
