Specialist - AAGI A&H Fax Claims

Job description

Is assigned to support Claims Hospital Fax Team.   Also, handle the fax claims received from hospitals, tracks and monitors to ensure that there is no the pending cases of fax claims, or back log.

1) Hospital Fax Claims
- Provide supports to team in handling the fax claims from the hospital.
- Check the information from fax claims documents, and record into the system.
- Support team to investigate and make decision for claims in the system, by covering the below actions:
   - Approve for the payment base on authorization.
   - Perform rejection of fax claims received.
   - Require the additional information.
   - Issue memo into the system for administration in performing next steps.
   - Submit for further investigation.
   - Request the hospital records from hospital.
- Continuously monitor and make decision for the pending cases of Claims Hospital Fax , or back log.

2) Hospital assessment  Claims (OPD cahless).
- Handling the  OPD cashless claims from the hospital.
- Perform investigation and make decision for OPd cashless claims received in the system.
- Approve for the payment base on authorization.
- Perform rejection of fax claims received.
- Require the additional information.
- Issue memo into the system for administration in performing next steps.
- Submit for further investigation.
- Request the hospital records from hospital.
- Continuously monitor and make decision for the pending cases of OPD cashless Claims Hospital , or back log.
- Manage the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization.

3) Support  
- Support Claim reimbursement.

Qualifications

- 0 to 2 years experience in Claims assessor , or other related fields in insurance industry

- Bachelor’s or Master’s Degree in Business Administration, Nursing, Business of Sciences (Medical Technology), or other related field.

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