Healthcare Claims Specialist

7 days ago


Hong Kong, Central and Western District, Hong Kong SAR China AIA Full time

DISCOVER YOUR POTENTIAL AT AIA

If you are committed to excellence, we invite you to explore this opportunity.

Position Overview

Responsible for evaluating and authorizing medical claims in alignment with established protocols and guidelines.

Key Responsibilities:

Review and process pre-authorization and pre-assessment requests in accordance with company policies; Manage clinical operations and day case claims based on assigned claims authority while adhering to established procedures; Address inquiries and resolve complaints from both external clients and internal stakeholders; Detect and investigate potentially fraudulent claims, escalating issues to supervisors as necessary; Contribute to system improvements and workflow modifications to enhance customer satisfaction and service quality; Perform additional tasks as directed by supervisors.

Qualifications:

Diploma or higher in any field with at least 5 years of relevant experience in medical claims, customer service, or complaint resolution; Professional certifications such as FLMI or FLHC are advantageous; Knowledgeable about medical claims operations and healthcare provider networks; Strong communication and interpersonal abilities; Detail-oriented with a solid sense of responsibility and organizational skills; Adaptable and focused on customer service; Capable of managing multiple tasks and thriving under pressure in a dynamic environment; Proficient in both written and spoken English and Chinese; Skilled in MS Office and Chinese Word Processing.

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