Sr. Specialist - AZAY Claim Quality Audit

Job description

Being responsible for claim quality audit and report preparation in timeline. Also, claim analysis project and the activities related to its results.  

'1. Claim Quality Audit
­ Regular claim quality review and feedback result to team.
       - 100% checking total Major and Death claims.
       - Random checking Reimbursement claims both individual and group (E-claim submission, Auto-Paid).
'2. Claim Monthly Report
­ Regular review and analyze claims data from IT.
­ Prepare the claim monthly report to team. 
­ Find out the abnormal claim pattern in various dimensions e.g. number of claim transactions, number of claimant, distribution channels and hospitals etc.
­ Cooperation with team and take actions in claims part such as high claim cases by doing not renew process, issue agent warning letter, closely claim monitoring and add their name list in UC file

Qualifications :

• 3 to 5 years experience in Nursing practice,Claims Management, 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.