DHS Claims Assessment_Reimbursement, Analyst
AIA Group · Ho Chi Minh City
Start building a career with purpose.
At AIA, your perspective, curiosity and ideas can contribute to our Purpose of helping millions of people live Healthier, Longer, Better Lives. Across our diverse markets, you will learn through meaningful work, collaborate with experienced colleagues and build practical skills as you turn fresh ideas into positive outcomes and a more sustainable future for our customers and communities.
Join us to explore new possibilities, grow through real experiences and start making an impact across Asia.
About the Role
Report to: Manager, DHS Claims Assessment
Location: Ho Chi Minh
Function: Customer & Information Technology | Department: Customer Claims - DHS Healthcare Claims
Type: Individual Contributor
THE OPPORTUNITY:
Manage and resolve claims in a fair, efficient, and empathetic manner to:
- Ensure that policyholders receive the appropriate compensation according to the terms and conditions of their insurance policies and ensure to bring the best claim experiences to customer.
- Minimize financial risks and protect company’s financial state (A/E) by identifying potential fraud and implementing preventive measures
ROLES AND RESPONSIBILITIES:
1.Re-imbursement claim handling (80%)
- Managing the entire lifecycle of insurance claims from submission to resolution to ensure claims are processed accurately and timely.
- Evaluating claims based on policy coverage, medical necessity, and contractual agreements.
- Ensuring that claims processing adheres to regulatory requirements and claims procedure.
- Providing guideline, advice to team member or make final decision for the borderline cases.
- Process payment, ensure policy benefit and policy values to be calculated correctly and pay to the right Beneficiary.
- Communicate with customers/ providers to request additional documents.
- Work with POS team/ actuary/ UW for Policy value calculation.
- Prepare claims letter and to customers and keep agents updated about claims status/ results.
- Quality Assurance: Monitoring and auditing claim handling processes to maintain accuracy and efficiency including conducting audits, providing feedback to leader, and implementing improvements.
- Customer Service: Addressing inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders.
- Provider Relationship: to ensure smooth operations between HC team and providers daily when dealing with direct billing.
2.Direct Billing claim handling (20%)
- Support or handle cashless claim in case of high volume of claims following manager directions.
- Back up assessor, who is responsible for direct billing hotline, in case of her/his absence.
JOB REQUIREMENTS:
- Education – University Graduate.
- Experience – At least 3 years of experience in medical claim at an insurance company
- Certifications/licenses – LOMA certificate
- Good in communication and interpersonal skill, decision-making skill, management skill and planning skill.
- Medical background is preferred.
- Customer Service Mindset
- Good in English speaking and writing
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.
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