Claim Accessor (Life & Health)

About the role Join Us as a Claim Accessor (Life & Health) reimbursement in our Head office. In this full-time role, you will be responsible for reviewing and processing insurance claims reimbursement, ensuring accurate and timely delivery of payments to our customers. Responsibilities Claims Reimbursement (Claim Direct) Assess and make decisions on reimbursement claims in accordance with guidelines and authorization limits. Approve or reject claims based on assessment criteria. Request additional documents or information when needed. Issue memos and update systems to support claim processing. Submit cases for further investigation when appropriate. Request hospital medical records to support assessments. Monitor pending and backlog cases, ensuring timely follow‑up and decision‑making. Consolidate complex cases and prepare documentation for Claim Committee and COO/CEO approval. OPD Cashless Claims (Hospital Assessment) Review and assess OPD cashless claims submitted by hospitals. Investigate cases and make claim decisions based on medical and policy guidelines. Approve payments within authorization limits. Reject improper claims following company and regulatory guidelines. Request additional hospital records or documents to finalize assessments. Monitor pending and backlog OPD cashless claims. Prepare complex cases for review by Claim Committee or management. Ensure claim decisions meet service standards and accuracy expectations. Qualifications Must Have Bachelor’s degree in Nursing, Medical Technology, Business Administration, or related field. Minimum 5 years of experience in claim assessment or related functions in the insurance industry. Strong knowledge of medical terminology, insurance claim processes, regulatory requirements, and assessment guidelines. Nice to Have High attention to detail and accuracy. Experience using claims or CRM systems. Strong prioritization and time‑management skills. Proficiency in MS Office , especially Advanced Excel , Power BI , and data processing software. Familiarity with AI tools (e.g., ChatGPT, Microsoft Copilot 365) is an advantage. What we offer At Allianz Ayudhya Assurance, we are committed to supporting our employees' professional and personal growth. You'll enjoy a comprehensive benefits package including health insurance, well benefits, flexibility culture and opportunities for career advancement. Our inclusive culture encourages work-life balance and values your wellbeing. Apply now to become our next Claim Accessor (Life & Health)!