Specialist - AAGI A&H Claims Payment CPU1

Job description

The position is responsible to registering and opening claim cases from both members and providers, verifying the accuracy of claim documentation, assessing policy coverage and benefit limits, and approving claim payments within assigned authority. The role acts as  a key liaison between customers, providers, and internal departments to ensure accurate and efficient claim processing while delivering a positive customer experience.

• Register and open claim cases from both memners and providers.
• Verify the accuracy and completeness of claim documents.
• Assess policy coverage and benefit limits in accordance with policy terms and conditions.
• Approve claim payments within assigned authority limits.
• Coordinate with relevant stakeholders(e.g., Underwriting, Provider Network, hospitals, or third parties) to obtain additional information when required.
• Record claim details and processing status accurately in the Claims Management System in a timely manner.
• Communicate and provide updates on claim status to members or providers.
• Support quality assurance checks and provide feedback for process improvement in claims operations.
• Other assignment

Qualifications 

Minimum 2 Years of experience in claims register/assessor or other related fields 

Bachelor’s Degree in Public Health (Medical Technology) or other related fields in insurance industry.

Any AI-future skills e.g., ChatGPT, or CoPilot 365, will be an advantage.