Medical Claims Specialist
2 weeks ago
About the Role
As a Medical Service, Advisor with AIA, you will play a critical role in handling and approving medical claims based on delegated claims authority in accordance with established procedures and guidelines.
Key Responsibilities
- Handle provider claims according to internal guidelines and maintain accurate records
- Provide timely and effective solutions to internal and external customer inquiries
- Manage disputes and complaints related to network services in accordance with established procedures and guidelines
- Stay up-to-date with network system administration and identify opportunities for improvement
- Investigate suspicious or fraudulent claims and escalate to superiors as necessary
- Contribute to system enhancements and workflow revisions to meet customer needs and service standards
- Support other teams in achieving company service standards and handle ad-hoc duties as assigned
Requirements
- Diploma holder or above in any discipline
- Minimum 2 years relevant experience in medical claims, customer services, or complaint management
- Professional qualifications in FLMI, FLHC, etc. are an advantage
- Familiarity with medical claims and healthcare network providers is essential
- Excellent communication and interpersonal skills
- Detail-minded with strong sense of responsibility and well-organized
- Flexible and customer-oriented with ability to handle multitasking and work under pressure
- Good command of both written and spoken English and Chinese
- Proficient in MS Office and Chinese Word Processing
Language: en
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