Medical Claims Examiner

4 weeks ago


Singapore RAFFLES HEALTH INSURANCE PTE. LTD. Full time
Medical Claims Examiner Job Summary

In this role at Raffles Health Insurance PTE. LTD., you will be responsible for managing medical claims from initial receipt to final resolution. Key Responsibilities:

Claim Eligibility Verification: Ensure accurate and timely verification of clients' eligibility for medical benefits.
Claims Processing: Process medical claims for both outpatient and inpatient services, adhering to strict timelines and quality standards.
Claim Data Entry: Accurately and efficiently enter claim data into our system, maintaining attention to detail and high levels of accuracy.
Claim Scanning and Sorting: Count, sort, and stamp all incoming claims received, ensuring efficient and organized processing.
Claims Rejection Letters: Prepare professional letters to clients informing them of rejected claims.
Claims Reimbursement: Process medical claims reimbursement and generate reports, ensuring transparency and accuracy.
Operational and System Issue Resolution: Troubleshoot and resolve operational and system issues, ensuring seamless claims processing.
Client Enquiries: Respond to client enquiries in a timely and professional manner, providing clear and concise information.

Required Skills and Qualifications:

Meticulous and Detail-Oriented: Possess strong attention to detail and accuracy in claim data entry and processing.
Responsive to Client Needs: Demonstrate a client-centric approach, responding promptly to client enquiries and concerns.
Team Player: Collaborate effectively with colleagues to ensure efficient claims processing and resolution.
Problem Solver: Possess strong analytical and problem-solving skills, resolving operational and system issues in a timely manner.
Adaptable and Willing to Learn: Be flexible and willing to learn and adapt to changing claims processing procedures and systems.
Familiarity with Microsoft Office: Possess strong skills in Microsoft Office applications, including Excel, Word, and PowerPoint.

In this role, you will have the opportunity to make a meaningful contribution to the claims processing team at Raffles Health Insurance PTE. LTD. and play a critical role in ensuring the timely and accurate processing of medical claims.
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