Medical Claims Specialist
1 week ago
About the Role
We are seeking a highly skilled and detail-oriented Medical Claims Specialist to join our team at AIA. As a Medical Claims Specialist, you will be responsible for handling and approving medical claims based on delegated claims authority in accordance with established procedures and guidelines.
Key Responsibilities:
- 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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