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- Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company's requirements and guidelines
- Adjudicate medical claims by following the organization guidelines & within the assigned authority limit.
- Establish covered medical insurance losses against benefits coverage and eligibility.
- Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required).
- Ensure confidentiality of all claims information, inclusive of claims guidelines and internal controls.
- Ensure claims are processed within the specified turnaround time
- To performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other 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.
Employee Benefits Claims Management, Analyst - Kuala Lumpur, Malaysia - AIA
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