Claims Assessment Specialist

We are looking for Claims Specialist to support Claims Manager assess healthcare claims to comply with Claims’ guidelines. In addition, you contribute as Subject Matter Expert in projects relating to enhance healthcare services. You shall work with dynamic, professional, and strong core values organization.
1. Responsibility:
• Supporting Manager to deliver excellent judgment, prompt, accurate claim assessment and excellent service to Health claims in accordance with Claims Department’s guidelines and procedures.
• Ensuring TPA’s claims assessment to meet Service Level Agreement (SLA);
• Working with Manager in claim services, preparation of Healthcare claims’ guidelines and procedures;
• Contribution as Subject Matter Expert in projects relating to enhance healthcare services;
• Supporting Manager to assess Healthcare claims as per prescribed authority limits; resolving complex claims and/or developing recommended solutions based on good judgment, initiative and technical skills;
• Collaboration with cross departments/functions to smoothly solve all claims-related issues and reach claims objectives;
• Duties to support Department targets and Company objectives as and when assigned by Team leader/Line Manager.
• Be in-charge of regular and ad-hoc reports for Claims Team, Claims VSO and COO.
• Take part in making user requirements for new products and testing them to make sure there are adequate features in the system for Claims users to use.
• Join projects of Claims CXT as SME role.

Professional development opportunities.
,#A competitive salary and benefits packages.
A focus on growing your career path with us.
Flexible work policies and strong work-life balance.
Values-first culture: We lead with our Values every day and bring them to life together.
Boundless opportuni

Collaboration, Critical Thinking, Microsoft Office, Problem-solving, Teamwork