DHS Claims Assessment_Reimbursement, Specialist

At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.

We're looking for a DHS Claims Assessment_Reimbursement, Specialist to report to the Manager, DHS Claims in Ho Chi Minh City.

THE OPPORTUNITY:

As a DHS Claims Assessment_Reimbursement, Specialist, you will manage and resolve claims in a fair, efficient, and empathetic manner to ensure policyholders receive the appropriate compensation according to the terms and conditions of their insurance policies.

ROLES AND RESPONSIBILITIES:

1. Re-imbursement claim handling(80%)

• Manage the entire lifecycle of insurance claims from submission to resolution.
• Evaluate claims based on policy coverage, medical necessity, and contractual agreements.
• Ensure claims processing adheres to regulatory requirements and claims procedure.
• Provide guidelines and advice to team members or make final decisions for borderline cases.
• Process payments and ensure policy benefits and values are calculated correctly.
• Communicate with customers and providers to request additional documents.
• Work with POS teams, actuaries, and underwriters for policy value calculations.
• Prepare claims letters to customers and keep agents updated about claims status and results.
• Conduct quality assurance and monitoring of claim handling processes.
• Address inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders.
• Ensure smooth operations between healthcare teams and providers.

2. Direct Billing claim handling(20%)

• Support or handle cashless claims in case of high volumes.
• Back up assessors responsible for direct billing hotlines.

JOB REQUIREMENTS:

• University graduate.
• At least 3 years of experience in medical claims at an insurance company.
• LOMA certificate.
• Good communication and interpersonal skills, decision-making skills, management skills, and planning skills.
• Medical background is preferred.
• Customer service mindset.
• Good English speaking and writing skills.