Individual Claims Management, Analyst

at  AIA

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
Responsible for determining the validity and authorising settlement of individual health insurance claims

Roles and Responsibilities:

• To support and lead a team of assessors in pre-certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company’s requirements and guidelines.
• To ensure quality audits are done for the respective team members.
• To pre-certify cases for issuance of guarantee letter in compliance to Company’s requirements and guidelines assist the team target productivity benchmark.
• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
• To assist in the assignment and monitoring of all documents received in their respective team’s queues.
• To assist WFM (workforce management) team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the guarantee letter process.
• To ensure huddles and communications are carried out as per the agreed frequency.
• To ensure coaching and engagement activities are carried out for performance improvement and cost containment.
• To ensure that cases of fee disputes are handled and resolved within targeted TAT.
• To ensure that error rate in guarantee letter issuance is less than the target.
• To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements.

Minimum Job Requirements:

• Candidate must possess at least a Bachelor’s Degree, Post Graduate Diploma, Professional Degree or Master’s Degree in Dentistry, Medicine, Medical Science, Biomedical, Nursing, Pharmacy, Pharmacology, Physiotherapy or equivalent.
• Candidate with claim experience is an added advantage.
• Fresh Graduate with medical background is encouraged to apply.
• Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge.
• Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs.
• Language: English and Bahasa Malaysia.
• Willing to adhere with 24/7 shift working arrangement.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.
You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date

• To support and lead a team of assessors in pre-certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company’s requirements and guidelines.
• To ensure quality audits are done for the respective team members.
• To pre-certify cases for issuance of guarantee letter in compliance to Company’s requirements and guidelines assist the team target productivity benchmark.
• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
• To assist in the assignment and monitoring of all documents received in their respective team’s queues.
• To assist WFM (workforce management) team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the guarantee letter process.
• To ensure huddles and communications are carried out as per the agreed frequency.
• To ensure coaching and engagement activities are carried out for performance improvement and cost containment.
• To ensure that cases of fee disputes are handled and resolved within targeted TAT.
• To ensure that error rate in guarantee letter issuance is less than the target.
• To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements