Dhs Claims Assessment, Specialist

2 weeks ago


Ho Chi Minh City, Ho Chi Minh, Vietnam AIA Full time
At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.

  • It's about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030._
  • And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business._
Sound like you? Then read on.

About the Role

Report to:
Manager, Healthcare Claims

Location:
Ho Chi Minh City

Function:
Customer Officer | Department: Digital Health Service

Role:
Individual Contributor

THE OPPORTUNITY
We are looking for DHS Claims Assessment, Specialist who

  • 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.

ROLE AND RESPONSIBILITIES

  • 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.
  • 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 accurate documentation, and if possible, recommendation on cases referred to higher authority level or to Claim Committee or reinsurers for decision.
  • Proactively give good practice, ideas to the team to improve team performance.
  • Performs other responsibilities and duties periodically assigned in order to support company's business.
  • 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

JOB REQUIREMENTS

  • University Graduate.
  • At least 2 years of experience in medical claim at an insurance company


Certifications/licenses
  • LOMA certificate
  • Good in communication and interpersonal skill, decisionmaking skill, management skill and planning skill.
  • Medical background is preferred.
  • Customer Service Approach
  • Good in English speaking and writing
  • Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives._

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