Description
The Claims Analyst is responsible for the overall review, assessment, and decision of claims.
Position Responsibilities:
- Determine eligible benefits based on documents submitted and policy provisions.
- Adjudicate claims and determine corresponding recommendation or decision within prescribed approval limits and within the defined turnaround time.
- Ensure accurate benefit payouts in accordance with the policy details, laws and regulations.
- Discuss claim decisions with distributors whenever necessary.
- Escalate possible fraudulent claims to the Team Lead and recommend appropriate action.
Required Qualifications:
- At least three (3) years experience in life and health claims
- Graduate of any four-year course; a medical course or legal background would be an advantage
- With industry certifications or exams passed (ALMI, etc.)
- Excellent written and oral communication skills
- Highly analytical
- Excellent understanding of life insurance policy provisions
- With good understanding of medical terms and common illnesses
- With knowledge and understanding of insurance laws and regulations
- Quick thinker and can work independently under pressure
