Medical Claim Assessor

JOB PURPOSE:
• This role is designed to performance all assessment activities of and make decisions accurately the claim case. Ensure the excellent and effective assessment plan, to help reduce complaints and increase satisfaction of customers during the make of claim decisions but still adhere to company strategies to ensure credibility. Have the vision and ability to enhance assessment method of claim case.
• Be able to provide the response to inquiries and complaints related to claims from claimants, advisors, other departments that are relevant to the make decision of the claim.
KEY RESPONSIBILITIES:
• Well perform the assessment process, ensure make accurate, reasonable and timely decisions and ensure the quality of claim service in the most competitive in the market.
• Ensure performing of assessment is done quickly and accurately, without errors. Meet the expectations of the Company and customers. Achieve customer satisfaction both inside and outside the Company.
• Ensure to provide the response to inquiries and complaints related to claims from claimants, advisors, other departments.
• Continuous improvisation of processes to shorten TAT, and improve claim experience.
• Good participate and excellently demonstrate responsibility for the claim professional assessment.
• Appraises and approves benefit claims within prescribed approval limits.
• Well handling and running during the daily work of an Assessor
• Participate in evaluation and analysis the claim cases to determine validity and give to make decision claim of exactly of coverage.
• Well assessment, always improve and update new claims assessment trends of the market.
• Ensuring the skills and ability to handle when the claim volume maybe increase suddenly.
• Join in guiding new members to improve their skills in viewing and evaluating claim documents.
• Co-operate with Legal depart. for seeking advice for complex cases that could lead to litigation. Co-operate with Compliance department for the fraud cases or suspected cases.
• Coordinate, support colleagues in all operations
• Support doing other tasks in Client Benefits Team if assigned or needed in case necessary