Claims Associate at Great Eastern Life Assurance Co Ltd

Cuenca, Azuay, Ecuador -

Full Time

Start Date

Immediate

Expiry Date

03 Feb, 26

Salary

0.0

Posted On

05 Nov, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Assessment, Customer Service, Analytical Skills, Attention to Detail, Communication Skills, Problem-Solving, Integrity, Teamwork, Adaptability, Regulatory Compliance, Medical Report Interpretation, Stakeholder Engagement, Quality Assurance, Service Excellence, Risk Management, Proactive Approach

Industry

Insurance

Description

Are you passionate about making a meaningful impact in the healthcare insurance space? Join us as a Medical Claims Associate, where you’ll play a vital role in ensuring our policyholders receive timely and accurate support when they need it most. As part of our dynamic Health Claims team, you’ll not only assess medical claims under our health plans—you’ll also be empowered to contribute to service excellence initiatives and exciting projects that enhance the overall claims experience. This is more than just a job; it’s a career path that builds deep expertise in claims assessment and customer care. 1. Assess Medical Claims Deliver accurate and timely assessment of medical claims, ensuring prompt and fair payouts in line with service standards. Conduct review of pending claim to ensure reserve adequacy and closure of claims in a timely manner. 2. Engage with Stakeholders Liaise professionally with medical institutions and policyholders to clarify outstanding requirements and ensure smooth claims processing. 3. Quality Checks Conduct quality checks on processed claims to uphold high standards of accuracy and compliance on straight-through processing engine. 4. Customer & Business Partner Relations Provide excellent service and strengthen relationships with customers and distribution channels through responsive and empathetic support. 5. Handle escalated claims enquiries Attend to claims-related queries with clarity, care, and professionalism. 6. Ensure Compliance • Adhere to internal policies and external regulatory requirements to maintain integrity and trust in our claims operations. • Take accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks; • Maintain awareness of industry trends on regulatory compliance, emerging threats and appropriate steps to mitigate the risks; and • Highlight any potential concerns/risks and proactively shares best risk management practices. • Have 1–3 years of experience in insurance claims handing, customer servicing, nursing or related ﬁelds (fresh graduates with strong interest in claims are welcome to apply). • Hold a Diploma or Degree in Business or Healthcare Administration, Nursing or any relevant discipline • Possess strong analytical skills and attention to detail, with the ability to interpret medical reports and policy terms • Are customer-focused, with excellent communication skills and a proactive approach to problem-solving • Are eager to learn and grow in a fast-paced, collaborative environment that values innovation and service excellence • Demonstrate high level of integrity, takes accountability of work and good attitude over teamwork • Takes initiative to improve current state of things and adaptable to embrace new changes

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Responsibilities

The Claims Associate will assess medical claims to ensure timely and accurate payouts while engaging with stakeholders for smooth claims processing. Additionally, they will conduct quality checks and handle escalated claims inquiries to maintain high service standards.