Employee Benefits Claims Management, Analyst

Roles & Responsibilities:

• Ensure completeness ofClaims/ Guarantee Letter Pre-certifydocumentsin compliance to Company’s requirements and guidelines

• Adjudicatemedical claims byfollowing theorganizationguidelines & within the assignedauthoritylimit.

• Establish covered medical insurance losses againstbenefitscoverage and eligibility.

• Establish proof of loss by studying medical documentation; assemblingadditionalinformation asrequiredfrom other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (ifrequired).

• Ensure confidentiality of all claims information,inclusive ofclaims guidelines and internal controls.

• ToidentifyProcess improvementideas &initiativesleading to greater operations effectiveness and efficiency.

• Ensure claims are processed within the specified turnaround time

• Toperformsother responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements.

Minimum Job Requirements:

• Bachelor’s degree or equivalent, in any field of study or with relevant background.
• Minimum of 5 years working experience preferably in the insurance or medical industry.
• Candidate with medical insurance/nursing/medical science/hospital background will be added advantage.
• Able to work in fast paced environment, independent, customer focused, result oriented & disciplined.
• Adaptable and able to work on own with minimal supervision.
• Ability to multi-task, plan effectively and meet deadlines.
• Service oriented/customers focus with sense of urgency and practice prioritization and critical thinking in jobs.
• Demonstrate good written and oral communication skills.
• Good knowledge of using Microsoft Office and others software applications especially reporting tools.
• Able to adapt in the face of constant changes in the organization.
• Good analytical, innovative and good in problem solving skill, ability to exercise judgment and take initiative to make decision and resolve problem(s).
• Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
• Able to work on rotating shifts.
• Contract position available.