Claim Assessment Specialist (Chuyên viên Thẩm định Bồi thường)

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

The Claim Assessment Specialist (Chuyên viên Thẩm định Bồi thường) will be responsible for assessing and processing healthcare claims in accordance with the company's policies and procedures.

Job Description

• Follow the Operating Manual to administer all types of claims, including reimbursement and direct billing cases
• Process daily claims volume within expected quality standards and turnaround time
• Assess claims accurately based on policy coverage, supporting documents, and medical necessity
• Identify and escalate suspicious or exceptional cases to supervisors or managers
• Update claims decisions and case status in relevant systems
• Rectify incorrect processing or claim decisions in a timely manner
• Participate in training and development activities

Job Requirements

• Degree in Biomedical Science, Allied Health, Nursing, or Biological Sciences
• Preferably experience in healthcare and/or claims for at least 1-3 years
• Healthcare and audit of insurance/hospital related skills
• Good customer service background on claims or healthcare claims
• Computer literate and familiar with MS Excel, MS Word, and MS PowerPoint