Claims Administrator (LOG) - English CV Only

For over 30 years, APRIL International has specialised in providing innovative international health insurance solutions. We design, distribute, and manage insurance plans and assistance services for individuals and businesses worldwide. With teams operating across Asia, Europe, and the Americas, we are committed to ensuring our members have access to the best care, no matter where they are.
As part of the APRIL Group, an insurance specialist with 3,000 staff members in 20 countries, we are dedicated to simplifying insurance and delivering exceptional customer experiences.
To sustain the growth of the company as well as the expansion of our services we are currently looking for a Senior Claims Administrator with a focus on Letter of Guaranty emission. Your role will be essential to provide peace of mind to our clients and accompany them in complex situations. Customer-centric and proactivity are a must.
Role Overview
The Claims Administrator (LOG) is responsible for the end-to-end processing of pre-authorization and Letter of Guarantee (LOG) requests. This role to review that all medical admissions and procedures align with policy terms and conditions. Ensure accurate coverage decision and cost containment in timely manner.
Key Responsibilities:
• Review and assess pre-authorization and Letter of Guarantee (LOG/GOP) requests to ensure alignment with policy terms and conditions.
• Evaluate medical information, treatment plans, and cost estimates to determine coverage eligibility.
• Negotiate with healthcare providers to secure preferential rates
• Ensure timely and accurate communication with hospitals, members, brokers, and internal teams regarding case status and decisions including inbound and outbound calls, fax and email.
• Monitor ongoing cases and provide updates to all relevant parties throughout the admission or treatment process.
• Identify potential risks such as non-disclosure, policy exclusions, or overutilization of benefits.
• Coordinate with medical advisors and underwriting teams when additional review or clarification is required.
• Ensure all documentation and decisions are properly recorded in the system in compliance with company standards.
• Finalize cases, ensuring completeness, accuracy, and proper closure within service level agreements (SLAs).
Why Join Us?
• You will further specialize in a sought-after profession
• You will integrate into a dynamic and committed team of professionals in a regional setting
• You will be offered development and career opportunities in a fast-growing tech-driven company.