Nurse Assessor

Your everyday

• Daily monitoring of all medical claims.
• Manage the expectation of customers in line with Company’s direction
• Verifying claims documents vs policy terms & conditions to ensure genuineness of claim within policy coverage
• Coordinate between customers, service providers to ensure excellent service
• Coordinating with Accident & Health team for medical opinion and claim approval & ensure targeted turnaround time is achieved
• Performing medical contact to gather information from hospitals/medical center
• Explaining medical problems to patients or their families
• Reviewing the treatment provided by hospitals is relevant to the case and in appropriate price
• Flag irregular/fraudulent/exaggerated claims to superior for further action
• Liaising with hospitals with a view to eliminating unnecessary or irrelevant treatment, over-servicing, over-charging and cost-containment
• Evaluating customer’s condition and arranging proper assistance to claimant
• Handling e-mail & all communication channels within targeted timeline
• Prepare weekly reporting on TAT, outstanding & repudiated cases
• Any other task/responsibility assigned by superior

Your profile

• 1-2 years of nursing or nurse claim assessor experience.
• Experience working under the Insurance department in the hospital or insurance and broker will be a big plus.
• Have a flexible schedule and must be able to work in shifts which may include night schedule and weekend.
• Able to work in commercial environment and fast moving business
• Good interpersonal and communication skills
• Computer literacy is essential
• Self-motivated, result oriented, ability to work under pressure, creative and energetic
• Willing to learn and can do attitude