Bring your career aspirations to life with AIA!Customer Claims
To ensure that the administration of Medical Claims constantly meet the department goals that aligns and contributes to the Corporate Strategy in terms of:
• Operational Efficiency
Position Objective:
• Cost Efficiency
• Responsiveness
• Quality
• Risk Management
• Expense Management
Roles and Responsibilities
Roles and Responsibilities:
General Tasks
1. Process and approve assigned Pre/Post/OAT Medical claims including Admission claims (if any, subject to guidance/advise by supervisor) and Hospital income claims within the stipulated TAT and authority limit.
2. Execute plan, projects, special assignments and task force assigned by Managers.
3. Execute ad-hoc assignments and task assigned by Team Leader.
4. Attend to e-mail enquiries and phone calls from agents on claim status
Specific Tasks
1. Review and approve Pre/Post/OAT Medical claims including Admission claims (if any, subject to guidance/advise by supervisor) and Hospital income claims within the granted approval authority limit.
2. To make recommendation to Managers for claims exceeding approval authority
3. Responsible for enquiries, correspondences and meet customers on more complex claims and claims related problems
4. Responsible for managing outstanding claims within standards.
5. Responsible for self-audit review
6. Liaison with adjusters, legal advisor, principal medical officer, medical institutions, relevant government bodies and other insurers to determine validity and liability of the Company.
7. Handles correspondence :
- general correspondence to customers
- standard letter to customers, doctors etc. for further information
- standard approval letter
8. To respond and settle all enquiries including Tips, Case360 / Customer Care & any other channels within 1 working day.
9. To achieve less than 0.25% error from QC sampling .
10. To achieve less 0% error recurrence
11. Team Goal - To achieve 95% cases process within T1 (next day) for MRDT only.
12. Team Goal – To achieve 95% cases process within T3
13. 100% suspense is resolved within 3WDs from the receipt date.
14. 100% Suppressed Payment to be issued within T+1
Financial and Non-Financial Measures:
• To complete work within turnaround time (TAT)
• Process and approve 60 PrePost/OAT/ claims daily Medical claims including Admission claims (if any, subject to guidance/advise by supervisor) and Hospital income claims or 45 mix cases per day.
• Other quantitative / qualitative measures, e.g. time, quality, feedback, etc., that are tied to the objective of the area of responsibilities.
Communication Requirements (Internal /External)
To liaise with :
• Other quantitative / qualitative measures, e.g. time, quality, feedback, etc., that are tied to the objective of the area of responsibilities.
• Agent / Customer
Build a career with us as we help our customers and the community live healthier, longer, better lives.
You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.
