At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.
Sound like you Then read on.
About the Role
We are looking for DHS Claims Assessment_Direct Billing, Analyst
Report to: DHS Claims Assessment, Lead
Location:Ho Chi Minh
Function: Customer & Information Technology |Department: Customer Office
Type: Individual Contributor
THE OPPORTUNITY:
- Manage direct billing claims within the Turnaround Time (TAT) of 2 hours for final LOG, 30 minutes for outpatient cases, ensuring a 99% accuracy rate. Collaborate effectively with medical provider staff and proactively engage with medical providers to ensure customers have the best experience and expenses are controlled reasonably.
- Maintain a customer-centric approach throughout the claim process, achieving a customer satisfaction score of 90% or higher.
- Actively contribute at least three creative ideas per quarter to the team to enhance performance and achieve claim cost savings of 10%
ROLES AND RESPONSIBILITIES:
1. Direct Billing handling (60%)
- Thoroughly and promptly assess all direct billing cases, ensuring claims decisions within Claim Authority are based on valid grounds and fully comply with Claim guidelines, policies, and terms and conditions.
- Collaborate closely with hospital staff to ensure treatment expenses are necessary and appropriate, avoiding unnecessary abuse.
- Utilize classification software to accurately apply clinical codes in the system for each sub-benefit.
- Document patients health information, including medical history, examination and test results, and any treatments or procedures provided.
- Maintain the confidentiality of all patient records.
- Achieve claims SLA commitments to customers, distribution, and partners.
- Prepare proper documentation and, if possible, provide recommendations on cases referred to higher authority levels, the Claim Committee, or re-insurers for decisions.
- Proactively contribute good practices and ideas to the team to improve performance.
- Perform other responsibilities and duties as periodically assigned to support the company's business
2.Reimbursement claim handling (30%)
- As a claim assessor, to be responsible for processing reimbursement claim if assigned by manager.
- Training for newcomers about the healthcare claim practice, medical knowledge if any.
3. Customer inquiries (10%)
- Handle customer calls regarding claim information outside of regular working hours to ensure clear and accurate information is provided.
JOB REQUIREMENTS:
- University Graduate.
- At least 3 years of experience in medical claim at an insurance company
- LOMA certificate
- 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
