Job Description
At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.
Sound like you? Then read on.
About the Role
Responsible for determining the validity and authorising settlement of group health insurance claims
Roles & Responsibilities:
Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company’s requirements and guidelinesAdjudicate medical claims by following the organization guidelines & within the assigned authority limit.Establish covered medical insurance losses against benefits coverage and eligibility.Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required).