Claims Assessor

1 day ago

Central Singapore PRUDENTIAL ASSURANCE COMPANY SINGAPORE (PTE) LIMITED Full time

**Location**
- Singapore, Central Singapore**Job Type**
- Full Time**Salary**
- $3,500 - $4,500 Per Month**Date Posted**
- 1 day agoAdditional Details

**Job ID**
- 116580**Job Views**
- 1Roles & Responsibilities

**Job Profile Summary**:
In this role, you will be involved in both Claims Assessment and Pre-authorisation.

Claims Assessment:
You will review, assess and approve shield claims within service turnaround time. As part of this dynamic role, you will report to Team Lead, PruShield Claims and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirements.

Pre-authorisation:
You will review request for pre-authorisation according to the procedures and adjudication process. You will also be required to liaise with hospitals and or doctors if the estimated medical bills are not within fee benchmark and other terms which fall outside of the agreed tariffs. You will be required to provide detailed and timely communication / outcome to all stakeholders namely the medical practitioners/providers / customers, financial consultants.

**Job Description (also includes pre-authorisation)**:

- Claim adjudication of Shield claims within service turnaround time and compliance with SOP and internal guidelines.
- Ensure output of assessment is accurate and compliant with internal policy and regulatory requirements.
- Attend to claims investigations (based on claims guidelines), service recovery and enquiry escalated from customer contact points
- Send and attend to clarification with hospitals and clinics
- Involve in projects assigned by supervisor (ad hoc) Provide quality customer service including interacting with Financial Consultants, customers when issues are escalated via customer contact points,
- Provide timely response to complaints
- Review appeals arising from rejected claims

Who are we looking for:
Competencies & Personal Traits
- Strong command of the English language (spoken and written)
- Familiarity with human anatomy, general diseases and disease management
- Detail-oriented and meticulous
- Exhibits collaborative and innovative mind-set
- Possesses good initiative and strong problem-solving skills
- Able to work in a fast-paced environment and under tight pressure
- Accountable and able to deliver work requirement within stipulated timelines Friendly and able to communicate and collaborate with Panel Hospitals/ Clinics with tact and timeliness
- Good negotiation skills
- Familiar with Microsoft Word and Excel

Working Experience
- At least 2 years of experience as a Life & Health claims assessor
- Experience in Shield Claims processing and pre-authorisation of claims are highly preferred Attained professional qualifications, eg: Health Insurance, LOMA, FLMI (Fellow, Life Management Institute etc.)

Education
- Degree holder preferable major in Biology & Life Sciences or Diploma in Nursing

Language
- Strong in English (both written and spoken)

Tags

claims

assessor

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