Claims Service Representative (In-Patient)-Health

Claim handling: Clinic admission notifications, filtering, coding, verification, data capture and processing of Claims Guide / Coach Claims Teams with respect to the medical aspects of claims Detect fraudulent or unwarranted items / treatment claimed

Main Responsibilities

• Claim handling: Clinic admission notifications, filtering, coding, verification, data capture and processing of Claims
• Guide / Coach Claims Teams with respect to the medical aspects of claims
• Detect fraudulent or unwarranted items / treatment claimed
• Assist In-Patient team in claims handling: input, verify & review data on IT system
• Liaise with Service Providers and Medical Consultants
• Provide assistance and information to clients and doctors at clinics’ help desk 
• Follow-up of incoming calls, mails and queries in a timely manner
• Communicate with PCL and respond to PCL queries
• Liaise with the different stakeholders and department teams
• Liaise with in-house Medical Officers
• Provide feedback to Coordinator/Team Leaders/Head of Claims and assist them in daily duties
• Any other cognate duties that may arise.

Qualifications and Experience

• Holder of a Higher School Certificate (HSC) or equivalent.
• Have at least 2 years Health Insurance and/ or General Insurance Market Knowledge and Practice
• Some medical knowledge and/or experience in the medical insurance sector would be an advantage
• Be customer-oriented.
• Be proactive, dynamic and result oriented.
• Well versed in policy wording, policy terms and conditions.
• Good interpersonal and communication skills (both oral and written).
• Be able to handle pressure to deliver against tight deadlines.
• Be a team player.
• Have an outgoing personality with good communications skills.
• Be well conversant with MS Office Tools (including PowerPoint) and with passion to excel.

The Company reserves the right:

1. To convene only the best qualified candidates to participate in the selection exercise.
2. Not to make any appointment following this advertisement.