Job Summary

We are currently assisting one of our clients, a leading insurance brokerage company, in searching for a Claim Analyst. This role will be responsible for managing and administering health insurance claims, with a primary focus on International Private Medical Insurance (IPMI) products.

The Claim Analyst will serve as a key liaison between clients, insurers, healthcare providers, and internal stakeholders to ensure efficient claims processing, accurate claim assessment, and exceptional client service. The successful candidate will possess strong knowledge of health insurance claims administration, medical terminology, policy interpretation, and international healthcare systems. They will also play a critical role in facilitating smooth claim resolutions while ensuring compliance with policy provisions and service standards.

Key Responsibilities

Claims Administration & Processing

• Review, analyze, and process health insurance claims in accordance with policy terms, conditions, exclusions, and insurer guidelines.
• Handle both cashless and reimbursement claims for IPMI policies.
• Verify claim eligibility, coverage limits, medical necessity, and supporting documentation.
• Coordinate with insurers, third-party administrators (TPAs), hospitals, clinics, and healthcare providers regarding claim assessments and approvals.
• Monitor claim status and ensure timely claim settlement within agreed service standards.
• Investigate and resolve claim discrepancies, disputes, and escalated claim issues.

Client & Stakeholder Management

• Act as the primary point of contact for clients regarding claim inquiries, claim procedures, and policy coverage explanations.
• Provide guidance to insured members on claim submission requirements and documentation.
• Liaise with insurance companies and healthcare providers to facilitate smooth claim handling and resolution.
• Maintain strong relationships with insurers and service providers to support effective claim management.

Policy & Coverage Analysis

• Interpret IPMI policy wordings, benefits schedules, exclusions, and underwriting provisions.
• Assess claim eligibility based on policy coverage and insurer guidelines.
• Identify potential claim risks, inconsistencies, or fraud indicators and escalate when necessary.

Reporting & Documentation

• Maintain accurate claim records and documentation in the company's systems.
• Prepare periodic claim reports, claim utilization analyses, and client claim summaries.
• Track claim trends and identify opportunities to improve claim processes and customer experience.
• Ensure compliance with internal procedures, regulatory requirements, and insurer service standards.

Service Excellence

• Deliver high-quality customer service while managing sensitive medical and claim-related information.
• Support client retention by providing professional and responsive claims assistance.
• Participate in claim review meetings with clients and insurers when required.

Requirements

Education

• Bachelor's Degree in Medicine, Nursing, Public Health, Pharmacy, Healthcare Administration, Insurance, or a related field.

Experience

• Minimum 3–5 years of experience in Health Insurance Claims, Medical Claims Administration, Employee Benefits, TPA, Insurance Company, or Insurance Broker environment.
• Hands-on experience handling International Private Medical Insurance (IPMI) claims is highly preferred.
• Experience managing international healthcare provider networks and overseas medical claims is an advantage.

Technical Knowledge

• Strong understanding of:
• International Private Medical Insurance (IPMI) products
• Health insurance claim processes
• Medical terminology and diagnosis coding
• Policy interpretation and benefit schedules
• Cashless and reimbursement claim procedures
• Healthcare provider billing practices
• Familiarity with major international insurers and IPMI providers is an advantage.

Skills & Competencies

• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.
• Effective communication and stakeholder management skills.
• Ability to manage multiple claims and priorities simultaneously.
• Strong customer service orientation.
• Proficient in Microsoft Excel, Word, and claims management systems.
• Good written and verbal English communication skills.