Bring your career aspirations to life with AIA!

The position is responsible to ensure that the administration work of Medical Claims are constantly meeting the department goals that align and contribute to the Corporate Strategy in terms of:
• Operational Efficiency
• Cost Efficiency
• Responsiveness
• Quality
• Risk Management
• Expense Management
• Process claims within Turn Around Time
• Handle ad-hoc assignment

Roles and Responsibilities:

General Tasks

• 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.

• Execute plan, projects, special assignments and task force assigned by Managers.

• Execute ad-hoc assignments and task assigned by Team Leader.

• Attend to e-mail enquiries and phone calls from agents on claim status.

Specific Tasks

• 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.

• Make recommendation to Managers for claims exceeding approval authority Responsible for enquiries, correspondences and meet customers on more complex claims and claims related problems

• Responsible for managing outstanding claims within standards.

• Responsible for self-audit review.

• Become liaison person with adjusters, legal advisor, principal medical officer, medical institutions, relevant government bodies and other insurers to determine validity and liability of the Company.

• Handles correspondence of general correspondence to customers, standard letter to customers, doctors, etc. for further information, and standard approval letter.

• Respond and settle all enquiries including Tips, Case360 / Customer Care & any other channels within 1 working day.

• Achieve less than 0.25% error from QC sampling size.

• Achieve less 0% error recurrence.

• Team Goal – Achieve 95% cases process within T1 (next day) for MRDT only.

• Team Goal – Achieve 95% cases process within T3.

• Ensure 100% suspense is resolved within 3WDs from the receipt date.

• Ensure 100% Suppressed Payment to be issued within T+1.

Minimum Job Requirements:

• Education: Bachelor's Degree in Administrative Studies, Biomedical / Technical Science, Nursing

• Years of Experience: Minimum 2 years of experience

• Technical Skills: Medical/ Life Claims assessment, Health Insurance Policy knowledge

• Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs

• Language: English and Bahasa Malaysia

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.