Senior Claims Examiner, A&H Claims

Key Objective

The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.

Key Accountabilities & Responsibilities

• Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis.

• Auditing cashless claims for Group and Individual hospitalisation and surgical claims.

• Overseeing and facilitating payment processing for bordereaux medical claims.

• Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements. 

• To monitor the performance of the appointed TPA and be proactive on liaising with TPA on resolving issues.

• Keeping constant communication with management and underwriting teams. 

• Providing feedback on any visible claims trends. 

• Monthly/Quarterly/Yearly review of aging files.
• Participate in Ad Hoc projects or tasks as assigned by supervisors.

 

• Experience in handling medical related claims.

• Have sound knowledge on both medical and claims practices.

• Able to read and interpret medical reports. 

• Strong attention to detail and accuracy in data entry, and document management.

• Critical thinking in evaluating authenticity of claims. 

• Familiarity with Microsoft Office Suite (Word, Excel, Outlook).

• Effective communication skills, both written and verbal.

• Proactive and have strong work ethics. 

• Willingness to learn and adapting to new processes and regulatory requirements.

• Ability to work collaboratively in a team environment and support multiple tasks.

• Professional attitude and discretion when handling confidential information.