Health Claim Operations, Analyst

Job Purpose: This position is responsible for claims processing by determining the validity of claims, identifying the needs for further investigation and following claims through settlement in accordance to claims processing guidelines to achieve productivities, service TAT, quality, FWA claims control framework Medical Necessity Control Admission necessity, Length of stay necessity, Treatment necessity (Procedures, investigation and Med supplies) Policy Eligibility Control Non-disclosure Moral Hazard Control Frequent claims (HB/ AI) Responsibilities: Review claims cases to determine validity and verification of coverage within own assigned authority; identify the need for further investigation and subsequent settle claims by acceptance or denial payment in accordance to claims processing guidelines contract provision include FWA claims control framework to ensure accuracy, completely and timely of claims settlement. Review pending cases and contact the medical providers and concerned parties to obtain information necessary to properly act upon claims processing as deemed appropriate, prepare over authority claims cases to superior for review and approval. Perform other duties as assigned. Qualifications: University degree in Medical Science(Nursing) or related field. At least 2-3 years work experience in claims operations or related field. Ability to communicate effectively both verbal and in writing. English proficiency and knowledge in using computer and software. Service minded and able to work under pressure. Good interpersonal skills. เพื่อให้เป็นไปตามมาตรฐานและนโยบายการคัดสรรบุคลากรของบริษัท เอไอเอ (ประเทศไทย) หลังผ่านการคัดเลือกแล้ว ผู้สมัครต้องได้รับการตรวจประวัติอาชญกรรมก่อนเริ่มงาน ทั้งนี้ บริษัทจะเก็บประวัติอาชญากรรมของท่านตามนโยบายข้อมูลส่วนบุคคลของบริษัท รายละเอียดตามลิงค์แนบ [https://www.aia.co.th/th/about-aia/privacy/candidate] In accordance with recruitment policy and hiring standard of AIA (Thailand) Company Limited, after completing the selection process, you are required for criminal background check before joining the company. Your criminal record information will be retained according to the PDPA policy of the company. As per attached link [https://www.aia.co.th/th/about-aia/privacy/candidate]