Senior Claim Assessor role, SingaporePrimary Location: Singapore
Additional Locations: SGP-Singapore Apply
Job Group Summary
Fast, accurate claims payment is one of the ways we make a difference in people's lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it's most needed.
Achieve superior claim and member service performance through an integrated process of operational, quality,medical cost, and resource management meeting and/or exceeding member, plansponsor, and provider expectations.
Reviews and adjudicates complex,sensitive, and/or specialized claims in accordance with claim processing guidelines. Acts as a subject matter expert by providing training, coaching, corresponding to complex issues. May handle customer service inquiries and problems.
Fundamental Components & Physical Requirements
·Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
·Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.
·Handles phone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
·Ensures all compliance requirements are satisfied and that all payments are made against company practices and procedures.
·Identifies and reports possible claim overpayments, underpayments and any other irregularities.
·Performs claim re-work calculations.
·Distributes work assignments daily to junior staff.
·Trains and mentors claim benefit specialists.
·Makes outbound calls to obtain required information for First claim or re-consideration.
·Trained and equipped to support call center activity if required, including general member and/or provider inquiries.
Background Experience Desired
·Experience in a production environment.
·Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
·2+ years claim processing experience.
·Claim processing experience.
Education and Certification Requirements
Associate's degree or equivalent work experience.
·Understanding of medical terminology.
·Strong knowledge of benefit plans, policies and procedures.
·Oral and written communication skills.
·Ability to maintain accuracy and production standards.
59401EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer
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