Dhs Claim Assessment direct Billing, Analyst
6 days ago
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
Function: Customer & Information Technology | Department: Customer Office
Type: Individual Contributor
Claim Assessment, Analyst (Direct Billing)
THE OPPORTUNITY:
- Manage direct billing claims within the Turnaround Time (TAT) of 2 hours for final LOG, 30 minutes for outpatient cases, ensuring a 99% accuracy rate. Collaborate effectively with medical provider staff and proactively engage with medical providers to ensure customers have the best experience and expenses are controlled reasonably.
- Maintain a customer-centric approach throughout the claim process, achieving a customer satisfaction score of 90% or higher.
- Actively contribute at least three creative ideas per quarter to the team to enhance performance and achieve claim cost savings of 10%
ROLES AND RESPONSIBILITIES:
1.Direct Billing handling (60%)
- Thoroughly and promptly assess all direct billing cases, ensuring claims decisions within Claim Authority are based on valid grounds and fully comply with Claim guidelines, policies, and terms and conditions.
- Collaborate closely with hospital staff to ensure treatment expenses are necessary and appropriate, avoiding unnecessary abuse.
- Document patients’ health information, including medical history, examination and test results, and any treatments or procedures provided.
- Maintain the confidentiality of all patient records.
- Achieve claims SLA commitments to customers, distribution, and partners.
- Prepare proper documentation and, if possible, provide recommendations on cases referred to higher authority levels, the Claim Committee, or re-insurers for decisions.
- Proactively contribute good practices and ideas to the team to improve performance.
- Perform other responsibilities and duties as periodically assigned to support the company’s business
2.Reimbursement claim handling (30%)
- 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.
3. Customer inquiries (10%)
- Handle customer calls regarding claim information outside of regular working hours to ensure clear and accurate information is provided.
JOB REQUIREMENTS:
- _ Education -_ _University Graduate.
- _ Experience -_ _At least 2 years of experience in medical claim at an insurance company
- _ Certifications/licenses_ -_ _LOMA certificate
- Good in communication and interpersonal skill, decision-making skill, management skill and planning skill.
- Medical background is preferred.
- Customer Service Mindset
- 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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