Claim Settlement

**Requirements**:

- Medical background/knowledge (Nurse/Midwife/Pharmacist)
- Minimum 2 year of employment in Insurance/TPA or similar industries
- Excellent knowledge of health insurance policy, health claim procedures, analytical and detail-oriented.
- Computer literate
- Well-versed in English, spoken and written. Certification from a University or a standardized test (IELTS, TOEFL) will be an advantage
- Willing to work in shifts
- Great personality, positive attitude, and able to work in a team

**Job responsibilities**
- Ensure medical procedures, examinations, and medications in accordance with the policy coverage plan.
- Ensure claim assessment and adjudication according to the diagnosis (clinical pathways), patient conditions
- Review claims to ensure the accuracy and made an adjustment as necessary
- Verify bill form hospitals or vendors and check completeness
- Processing requirements and makes correction as necessary
- Follow up on incomplete request
- Generate daily report
- Work in alignment with SOP and regulations of the Department
- Work closely with Team members to provide the necessary and best services for Clients