Claim Benefit SpecialistPrimary Location: Singapore, SGP
Additional Locations: SGP-Singapore Apply
- Analyzes and approves claims.
- Completes work with a limited degree of supervision
- Assesses claims up to given Authority limit
- Seek advice from designated Specialists on complicated cases or claims above authority limit. (Senior Claim Benefits Specialist and Claim Supervisor/Manager).
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
- Identify and investigate claims for possible abuse and fraud.
- Conducts outreach activities including but not limited to email, member calls, provider calls as part of the claims adjudication process
- In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and all systems within specified turn-around-time parameters.
- Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., use of all documented resources).
- Comprehend with complex workflows and come up with a customer-centric solution within reasons
- Escalate unresolved claims complaints and high costs claims to the claims supervisor for guidance.
- Continually work to improve best practices procedures and standards.
- Ensures compliance with requirements of regional compliance authority/industry regulator.
- Adheres to international privacy policies, practices and procedures.
- Develop knowledge, skills and experience in a variety of Operational disciplines and processes
- Display fantastic oral and written communication skills
- Establish relationships with internal and external customers
- Act proactively, take ownership of problems and be empowered to take actions to resolve our members' concerns.
- Be resilient and adaptable to changes in priorities, distressed customers or high volumes
- Deliver an experience, not just a service
- 2 years’ experience in a healthcare claims environment.
- Claim assessment experience.
- Requires specialized skills in one area or breadth of knowledge across multiple areas.
- The ability to read in Mandarin is preferred due to the territory needs.
- High School graduate or local market equivalent.
- Certificate in Basic Insurance Concepts and Principles (BCP)
- Ability to maintain accuracy and production standards.
- Analytical skills.
- Technical skills.
- Excellent communication skills.
- Oral and written communication skills.
- Understanding of medical terminology.
68695EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer
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