Medical Claims Examiner

3 days ago


Singapore beBeeAdjudicator Full time $70,000 - $110,000
Job Opportunity

The role of Medical Adjudication Specialist involves reviewing and evaluating complex medical claims, identifying potential fraud or abuse. This position requires expertise in clinical decision-making, analytical thinking, and effective communication to collaborate with healthcare providers and internal stakeholders.

Key Responsibilities:
  • Medical Claim Evaluation: Conduct thorough reviews of medical claims to ensure fairness, consistency, and compliance with regulatory frameworks.
  • Collaboration with Stakeholders: Investigate questionable claims, negotiate with service providers, and provide expert recommendations on emerging trends.
  • Communication: Explain adjudication outcomes to agents, administration teams, and policyholders, ensuring clarity and transparency.
Requirements:
  • Clinical Experience: 3-5 years of experience in clinical settings with a strong understanding of surgical codes and procedures.
  • Analytical Thinking: Excellent clinical reasoning and analytical thinking skills.
  • Communication Skills: Effective communication and negotiation skills to deal with policyholders, agents, and healthcare providers.
  • Computer Literacy: Proficient in Microsoft Word and Excel.
Preferred Qualifications:
  • Insurance Experience: Insurance-related and health insurance adjudication experience is desirable.
  • Nursing Background: Suitable for nurses seeking a career change.

  • Claims Examiner

    22 hours ago


    Singapore beBeeInsurance Full time

    Job Title: Claims Examiner We are seeking a skilled Claims Examiner to join our team. Key Responsibilities: Ensure timely and accurate claims processing. Communicate effectively with customers, stakeholders, and support staff. Administer motor claims and review claim files. Monitor recoveries and set reserves as needed. Participate in claims...

  • Claims Examiner

    7 days ago


    Singapore beBeeInsurance Full time $4,600

    Job Title:Claims ExaminerWe are seeking a skilled Claims Examiner to join our team.Key Responsibilities:Ensure timely and accurate claims processing.Communicate effectively with customers, stakeholders, and support staff.Administer motor claims and review claim files.Monitor recoveries and set reserves as needed.Participate in claims efficiencies projects...


  • Singapore beBeeCareer Full time $60,000 - $100,000

    Job OverviewWe are seeking a seasoned Medical Adjudication Specialist to join our team.About the Role:The selected candidate will be responsible for reviewing and adjudicating complex medical claims to identify potential fraud, waste, or abuse.They will collaborate with medical providers and internal stakeholders to investigate questionable claims and...


  • Singapore Everest Re Group, Ltd. Full time

    Title: Reinsurance Claims Examiner Company: Everest Reinsurance Company (Singapore) Job Category: Claims Job Description: About Everest It’s an exciting time for Everest! As we continue our journey, we see significant opportunity ahead of us to expand our reach, build diversity, and enhance our capabilities in critical markets. Everest Group, Ltd....


  • Singapore Alliance Healthcare Group Limited Full time

    We are seeking dynamic professionals to join our claims team in our corporate managed healthcare business segment. **Responsibilities**: Claims Management - Outpatient and Inpatient Medical Claims - Understand and examine the provisions of medical policies to determine the patient’s/member’s level of medical coverage against the terms and conditions of...


  • Singapore beBeePatientBillingServices Full time

    We are seeking a highly skilled Patient Billing Services Manager to join our organization. As a key member of the team, you will play a vital role in ensuring seamless patient billing services.Job SummaryThe Patient Billing Services Manager will be responsible for overseeing all aspects of patient billing, including financial counseling, bill preparation,...


  • Singapore beBeeClaim Full time $120,000 - $200,000

    Job OverviewWe are seeking a skilled professional to fill the role of Claims Assessor. The ideal candidate will be responsible for reviewing, assessing and approving shield claims within a set timeframe.Main Responsibilities:Conduct thorough reviews of shield claims to ensure accuracy and compliance with internal policy and regulatory...


  • Singapore US Office of Workers' Compensation Programs Full time

    **Duties**: This position is Outside the bargaining unit. For the Supervisory Workers' Compensation Claims Examiner (District Director) GS-0991-15: - The incumbent actively contributes to and supports a comprehensive and integrated program to ensure effective implementation of benefits under the compensation provisions of the DMCWC program. - Provides...

  • Claims Examiner

    3 days ago


    Singapore Chubb Full time

    **Areas of Responsibility** **Claims Service** - Work within local and regional on operating processes and claim handling procedures to ensure that quality claim service is rendered to all customers in accordance with Chubb Claims Philosophy. - Attend to claim enquiries and feedback, maintain positive relationship with all customers, brokers, service...

  • Claims Examiner

    3 days ago


    Singapore Combined Insurance Full time

    **Areas of Responsibility** **Claims Service** - Work within local and regional on operating processes and claim handling procedures to ensure that quality claim service is rendered to all customers in accordance with Chubb Claims Philosophy. - Attend to claim enquiries and feedback, maintain positive relationship with all customers, brokers, service...