The Health Insurance Claims Officer is responsible for accurately and quickly resolving customers' insurance applications; Ensure compliance with Contract principles, Health Insurance Program, compensation practices prescribed by the Insurance Company as well as internal processes.
New employees will receive professional training to perform the following tasks:
- Check the completeness/insufficiency and reasonableness of insurance documents. Contact customers to handle documents lacking documents. Make sure to collect enough reasonable supporting documents for the dossier.
- Implement risk control & automatic compensation calculation on the system.
- Evaluate the results received by comparing with the Insurance contract and compensation practices prescribed by the Insurance company.
- Make compensation decisions by collecting & verifying all relevant information such as legality, compensation conditions, insurance benefits.
- Identify complex, suspicious, controversial records and report to Management for evaluation; At the same time, make suggestions for solutions.
- Review disputes related to insurance documents to find solutions.
- Comply with regulations on safety and data security.
- Comply with regulations, policies, procedures and standards of the Company.
- Other tasks assigned by the Company.