Claims Assessor

Position Objective: - Adjudicate medical reimbursement claims within TAT and ensure to detect fraud, waste, and abuse claim by using medical knowledge. - Perform customer centricity during the claim process. - Proactively contribute creative ideas to the team to improve team performances Roles and Responsibilities 1. Claims Assessment (80%) • Ensure all claim cases are assessed thoroughly and carefully and claims decisions within Claim Authority are made based on valid grounds as well as in full compliance with Claim guidelines/policies/ T&C. • Examine patients’ medical records to ensure accuracy and completeness. • Operate classification software to apply the correct clinical codes in system for reimbursement. • Document patients’ health information, including medical history, examination and test results, and any treatments or procedures provided. • Preserve confidentiality of all patient records • Ensure to achieve claims SLA commitments to customers, distribution, and partner. • Prepare proper documentation, and if possible, recommendation on cases referred to higher authority level or to Claim Committee for decision. • Proactively contribute good practice, ideas to the team to improve team performance. • Performs other responsibilities and duties periodically assigned in order to support company’s business. 2) Medical advisor: (20%) - As a medical doctor, to be responsible for advising medical knowledge to other assessors cross other teams. - Back up assessor, who is responsible for direct billing hotline, in case of her/his absence.

• Education – University Graduate. • Experience – At least 2 years of experience in medical claim at an insurance company • Certifications/licenses – LOMA certificate • Special skills: Good in communication and interpersonal skill, decision-making skill, management skill and planning skill. Medical background is preferred. • Customer Service Mindset • Good in English speaking and writing

13th payment, Healthcare for you and your family