Medical Claims Specialist
1 month ago
About AIA and This Role
AIA is a leading life insurance company, and this role is a key part of our team.
Key Responsibilities
This Medical Claims Specialist will be responsible for handling and approving medical claims based on delegated claims authority in accordance with established procedures and guidelines.
Accountabilities
- Process pre-authorisation and pre-assessment cases according to policies and guidelines;
- Process clinical operation and day case claims based on delegated claims authority in accordance with established procedures and guidelines;
- Handle enquiries and complaints from both external and internal parties;
- Identify and investigate suspicious / fraudulent claims, and escalate cases to supervisor(s) where appropriate;
- Assist in system enhancement and workflow adjustment to meet customers' needs and service standard;
- Handle ad-hoc duties as assigned by supervisor(s).
Requirements
- Diploma holder or above in any disciplines with minimum 5 years of relevant experience in medical claims, customer services or complaint management;
- Professional qualification in FLMI, FLHC, etc. will be an advantage;
- Familiar with operation of medical claims and healthcare network providers;
- Good communication and interpersonal skills;
- Detail-minded with strong sense of responsibilities and well-organized;
- Flexible and customer-oriented;
- Able to handle multi-task and work under pressure in a fast paced environment;
- Good command of both written and spoken English and Chinese;
- Proficient in MS Office and Chinese Word Processing.
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