Job Opportunities API

Your everyday • Daily monitoring of all medical claims. • Manage the expectation of customers in line with Company’s direction • Verifying claims documents vs policy terms & conditions to ensure genuineness of claim within policy coverage • Coordinate between customers, service providers to ensure excellent service • Coordinating with Accident & Health team for medical opinion and claim approval & ensure targeted turnaround time is achieved • Performing medical contact to gather information from hospitals/medical center • Explaining medical problems to patients or their families • Reviewing the treatment provided by hospitals is relevant to the case and in appropriate price • Flag irregular/fraudulent/exaggerated claims to superior for further action • Liaising with hospitals with a view to eliminating unnecessary or irrelevant treatment, over-servicing, over-charging and cost-containment • Evaluating customer’s condition and arranging proper assistance to claimant • Handling e-mail & all communication channels within targeted timeline • Prepare weekly reporting on TAT, outstanding & repudiated cases • Any other task/responsibility assigned by superior Your profile • 1-2 years of nursing or nurse claim assessor experience. • Experience working under the Insurance department in the hospital or insurance and broker will be a big plus. • Have a flexible schedule and must be able to work in shifts which may include night schedule and weekend. • Able to work in commercial environment and fast moving business • Good interpersonal and communication skills • Computer literacy is essential • Self-motivated, result oriented, ability to work under pressure, creative and energetic • Willing to learn and can do attitude