In this role, you will review, assess, and approve Accident & Health claims within service turnaround time. As part of this dynamic role, you will report to Team Lead, A&H Claims and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirements.
Job Description:
- Adjudicate Accident & Health (A&H) claims and ensure delivery of prudent and equitable claims decision within expected service level.
- Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
- Manage claims investigation by working with claimants, financial consultants, medical institutions, insurers, etc to determine claims decision and payment.
- Follow up on outstanding requirements needed for claims adjudication through documented follow-up process and provide regular update on claims status.
- Work closely with other business units to ensure that claims are processed accurately and that all service level agreements are met.
- Manage enquiries and appeals arising from claims
Who we are looking for:
Competencies & Personal Traits
- Excellent communication, interpersonal and problem-solving skills with ability to investigate, evaluate and reach an appropriate decision
- Customer-centric with ability to work under pressure
- Self-motivated and able to work independently
- Team player, mature, with excellent leadership quality.
- Good medical knowledge and claims settlement procedures
Working Experience
- At least 1-2 years of experience as a Life & Health claims assessor
