DHS Claims Assessment_Reimbursement, Specialist

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

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

THE OPPORTUNITY:

We are looking for an Agency Digital Transformation, Consultant who is 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:

• Education University Graduate.

• Experience -At least 3 years of experience in medical claim at an insurance company

• Certifications/licenses 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