Claim Assessment Senior Specialist (Chuyên viên Cấp cao Dịch vụ Thẩm định Bồi thường)

Prudential's purpose is to be partners for every life and protectors for every future.

The Claim Assessment Senior Specialist will be responsible for assessing and processing healthcare claims for both reimbursement and direct billing cases in accordance with the Operating Manual, service level standards, and quality requirements.

Key responsibilities:

• Process daily claims volume within expected quality standards and turnaround time
• Conduct regular assessments and make decisions on claims
• Update claims decisions, assessment comments, and case status accurately in relevant systems
• Rectify any incorrect processing or claim decisions in a timely manner
• Communicate with customers, hospitals, or providers professionally when required
• Maintain productivity and quality standards, and provide explanations on performance gaps when required
• Participate in training, development activities, and other duties or projects assigned by management

Requirements:

• Degree in Biomedical Science, Allied Health, Nursing, or Biological Sciences
• Preferably 2-5 years of experience in healthcare and/or claims
• Good knowledge of life insurance claims processing and healthcare-related skills
• Computer literate and familiar with MS Excel, MS Word, and MS PowerPoint
• Innovative, self-assured, and results-oriented