Medical Claims Specialist

4 weeks ago


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

About the Role

As a Medical Claims Specialist at AIA, 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;
  • Perform ad-hoc duties as assigned by supervisor(s).

Requirements:

  • Diploma holder or above in any discipline 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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