Nurse Claim Assessor

16 hours ago

กรงเทพมหานคร, Thailand Sunday Insurance Full time

Daily monitoring of all medical / travel claims
- Manage the expectation of customers in line with Company’s direction
- Verifying claims documents vs policy terms & conditions to ensure genuineness of

claim within policy coverage
- Coordinate between customers, broker, service providers to ensure excellent service
- Coordinating with A&H team for medical opinion and claim approval & ensure targeted

turnaround time is achieved
- Performing medical contact to gather information from hospitals/medical center
- Explaining medical problems to patients or their families
- Reviewing the treatment provided by hospitals is relevant to the case and in

appropriate price
- Flag irregular/fraudulent/exaggerated claims to superior for further action
- Liaising with hospitals with a view to eliminating unnecessary or irrelevant treatment,

over-servicing, over-charging and cost-containment
- Evaluating customer’s condition and arranging proper assistance to claimant
- Prepare weekly reporting on TAT, outstanding & repudiated cases
- Keep abreast of medical knowledge, policy terms & conditions and coach/mentor the

A&H team
- Auditing claims to determine the accuracy of approvals made, the completeness of

the documentation for each record according to appropriate policies and procedures

and proper medical billing, maintain compliance with laws & regulations within A&H

team.
- Any other task/responsibility assigned by superior

**Qualification**
- Minimum 3 years in nursing experience and/or life or health insurance company
- Able to work in commercial environment and fast moving business
- Good interpersonal and communication skills
- Computer literacy is essential
- Self-motivated, result oriented, ability to work under pressure, creative and energetic

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