Medical Claims Specialist
2 months ago
About the Role
As a Medical Claims Specialist at AIA, you will play a critical role in ensuring the smooth handling and approval of medical claims in accordance with established procedures and guidelines.
Key Responsibilities:
- Handle and approve medical claims based on delegated claims authority, adhering to internal guidelines and procedures.
- Provide exceptional customer service by responding to internal and external customer inquiries, offering solutions and information within standard turnaround times.
- Manage disputes and complaints related to network services, following established procedures and guidelines.
- Maintain up-to-date knowledge of network systems and their administration.
- Identify and investigate suspicious or fraudulent claims, escalating issues 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.
- Perform ad-hoc duties assigned by superiors.
Requirements:
- Diploma holder or above in any discipline.
- Minimum 2 years of relevant experience in medical claims, customer service, or complaint management.
- Professional qualifications in FLMI, FLHC, etc. are advantageous.
- Familiarity with medical claims and healthcare network providers.
- Excellent communication and interpersonal skills.
- Detail-oriented with a strong sense of responsibility and organization.
- Flexible and customer-focused.
- Able to handle multiple tasks and work under pressure in a fast-paced environment.
- Proficient in MS Office and Chinese Word Processing.
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