DHS Claims Assessment_Reimbursement, Specialist

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

We are looking for an Agency Digital Transformation, Consultant who is manage and resolve claims in a fair, efficient, and empathetic manner to:

• Ensure that policyholders receive the appropriate compensation according to the terms and conditions of their insurance policies and ensure to bring the best claim experiences to customer.

• Minimize financial risks and protect company’s financial state (A/E) by identifying potential fraud and implementing preventive measures

• Managing the entire lifecycle of insurance claims from submission to resolution to ensure claims are processed accurately and timely.

• Evaluating claims based on policy coverage, medical necessity, and contractual agreements.

• Ensuring that claims processing adheres to regulatory requirements and claims procedure.

• Providing guideline, advice to team member or make final decision for the borderline cases.

• Process payment, ensure policy benefit and policy values to be calculated correctly and pay to the right Beneficiary.

• Communicate with customers/ providers to request additional documents.

• Work with POS team/ actuary/ UW for Policy value calculation.

• Prepare claims letter and to customers and keep agents updated about claims status/ results.

• Quality Assurance: Monitoring and auditing claim handling processes to maintain accuracy and efficiency including conducting audits, providing feedback to leader, and implementing improvements.

• Customer Service: Addressing inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders.

• Provider Relationship: to ensure smooth operations between HC team and providers daily when dealing with direct billing.

• Support or handle cashless claim in case of high volume of claims following manager directions.

• Back up assessor, who is responsible for direct billing hotline, in case of her/his absence.

• Education – University Graduate.

• Experience – At least 3 years of experience in medical claim at an insurance company

• Certifications/licenses – LOMA certificate

• Good in communication and interpersonal skill, decision-making skill, management skill and planning skill.

• Medical background is preferred.

• Customer Service Mindset

• Good in English speaking and writing

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.