Claims Assessor, Analyst

* Position Objective:
- Handle direct billing claims within TAT and ensure to collaborate with medical provider staff well, proactively discuss with medical provider to give customer the best experiences and control expense reasonably.
- Perform customer centricity during the claim process.
- Proactively contribute creative ideas to the team to improve team performances and claim cost savings.
* Roles and Responsibilities:
1. Direct Billing handling (80%)
• Ensure all direct billing cases are assessed thoroughly and timely and claims decisions within Claim Authority are made based on valid grounds as well as in full compliance with Claim guidelines/policies/ T&C.
• Work closely with hospital staff to ensure the treatment expenses are necessary and appropriate and avoid the abuse unnecessary.
• Operate classification software to apply the correct clinical codes in system for each sub-benefits.
• Document patients' health information, including medical history, examination and test results, and any treatments or procedures provided.
• Preserve confidentiality of all patient records
• Ensure to achieve claims SLA commitments to customers, distribution, and partner.
• Prepare proper documentation, and if possible, recommendation on cases referred to higher authority level or to Claim Committee or re-insurers for decision.
• Proactively contribute good practice, ideas to the team to improve team performance.
• Performs other responsibilities and duties periodically assigned in order to support company's business.
2. Reimbursement claim handling: (20%)
• As a claim assessor, to be responsible for processing reimbursement claim if assigned by manager.
• Training for newcomers about the healthcare claim practice, medical knowledge if any.