Claim Settlement

Requirements:

• Medical background/knowledge (Nurse/Midwife/Pharmacist)
• Minimum 2 year of employment in Insurance/TPA or similar industries
• Excellent knowledge of health insurance policy, health claim procedures, analytical and detail-oriented.
• Computer literate
• Well-versed in English, spoken and written. Certification from a University or a standardized test (IELTS, TOEFL) will be an advantage
• Willing to work in shifts
• Great personality, positive attitude, and able to work in a team

Job responsibilities

• Ensure medical procedures, examinations, and medications in accordance with the policy coverage plan.
• Ensure claim assessment and adjudication according to the diagnosis (clinical pathways), patient conditions
• Review claims to ensure the accuracy and made an adjustment as necessary
• Verify bill form hospitals or vendors and check completeness
• Processing requirements and makes correction as necessary
• Follow up on incomplete request
• Generate daily report
• Work in alignment with SOP and regulations of the Department
• Work closely with Team members to provide the necessary and best services for Clients