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Healthcare Claims Specialist
2 months ago
DISCOVER YOUR POTENTIAL AT AIA
If you are passionate about healthcare and claims management, we want to hear from you.
Position Overview
Responsible for the evaluation and authorization of medical claims in line with established protocols and guidelines.Key Responsibilities:
Evaluate pre-authorization and pre-assessment requests according to company policies; Review clinical operations and day case claims based on assigned claims authority in compliance with 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; Excellent communication and interpersonal abilities; Detail-oriented with a strong 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.