Junior Claim Investigator

JOB PURPOSE:
• This role is designed to perform with doing the investigation of all claims that need to clarify the true cause of an insurance event, to help assess claim promptly and accurately for clients but at the same time comply with company strategies to ensure credibility.
• Be able to the proactively set the orientation of the investigation for efficiency verification in each case claim. Honest and fair working criteria.
MAIN RESPONSIBILTIES:
• Doing investigate in the claim cases need investigation. Always finding the most effective verification methods but must follow the law and compliance rule. (25%)
• Regularly discuss and seek support from more senior managers or colleagues for cases of over verification ability or complicated. Guaranteed standard verification times for all cases. (20%)
• Strengthen connectivity and establish legally relationships with hospital partners. Self-control of time and plan of the investigation. Control strict the investigate time within TAT claim limits. (20%)
• Review claim cases and require for further information if see necessary during investigation. Coordinate control investigation expenses reasonably and ensure compliance with regulations on expenses. (10%)
• Co-operate with Legal for seeking advice for complex cases that could lead to litigation. Co-operate with Compliance department for the fraud cases or suspected cases. (10%)
• Handle complaints related and respond enquiries that related to claims from clients, advisor, CM, other departments. (5%)
• Participate in the assess and give claim decision within approval limit when necessary (if any) (5%)
• Coordinate, support colleagues in all operations. Execute and comply with other tasks assigned by manager and leader. (5%)