DHS Claims Assessment_Reimbursement, Analyst

Start building a career with purpose.

About the Role

Report to: Manager, DHS Claims Assessment
Location:Ho Chi Minh
Function: Customer & Information Technology |Department: Customer Claims - DHS Healthcare Claims
Type: Individual Contributor

THE OPPORTUNITY:

Manage and resolve claims in a fair, efficient, and empathetic manner to:

• Ensure that policyholders receive the appropriate compensation according to the terms and conditions of their insurance policies and ensure to bring the best claim experiences to customer.
• Minimize financial risks and protect company's financial state (A/E) by identifying potential fraud and implementing preventive measures

ROLES AND RESPONSIBILITIES:

1.Re-imbursement claim handling (80%)

• Managing the entire lifecycle of insurance claims from submission to resolution to ensure claims are processed accurately and timely.
• Evaluating claims based on policy coverage, medical necessity, and contractual agreements.
• Ensuring that claims processing adheres to regulatory requirements and claims procedure.
• Providing guideline, advice to team member or make final decision for the borderline cases.
• Process payment, ensure policy benefit and policy values to be calculated correctly and pay to the right Beneficiary.
• Communicate with customers/ providers to request additional documents.
• Work with POS team/ actuary/ UW for Policy value calculation.
• Prepare claims letter and to customers and keep agents updated about claims status/ results.
• Quality Assurance: Monitoring and auditing claim handling processes to maintain accuracy and efficiency including conducting audits, providing feedback to leader, and implementing improvements.
• Customer Service:Addressing inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders.
• Provider Relationship:to ensure smooth operations between HC team and providers daily when dealing with direct billing.

2.Direct Billing claim handling (20%)

• Support or handle cashless claim in case of high volume of claims following manager directions.
• Back up assessor, who is responsible for direct billing hotline, in case of her/his absence.

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