Mô tả công việc
Start building a career with purpose.
At AIA, your perspective, curiosity and ideas can contribute to our Purpose of helping millions of people live Healthier, Longer, Better Lives. Across our diverse markets, you will learn through meaningful work, collaborate with experienced colleagues and build practical skills as you turn fresh ideas into positive outcomes and a more sustainable future for our customers and communities.
Join us to explore new possibilities, grow through real experiences and start making an impact across Asia.
About the Role
- Report to: Manager, DHS Claims Assessment
- Location: Ho Chi Minh
- Function: Customer & Information Technology | Department: Customer Claims - DHS Healthcare Claims
- Type: Individual Contributor
THE OPPORTUNITY
Manage and resolve claims in a fair, efficient, and empathetic manner to:
- Ensure that policyholders receive the appropriate compensation according to the terms and conditions of their insurance policies and bring the best claim experiences to customers.
- Minimize financial risks and protect the company’s financial state (A/E) by identifying potential fraud and implementing preventive measures.
ROLES AND RESPONSIBILITIES
1. Reimbursement claim handling (80%)
- Managing the entire lifecycle of insurance claims from submission to resolution to ensure claims are processed accurately and timely.
- Evaluating claims based on policy coverage, medical necessity, and contractual agreements.
- Ensuring that claims processing adheres to regulatory requirements and claims procedures.
- Providing guidelines, advice to team members or making final decisions for borderline cases.
- Processing payments, ensuring policy benefits and values are calculated correctly and paid to the right beneficiary.
- Communicating with customers/providers to request additional documents.
- Working with POS team, actuary, and UW for policy value calculation.
- Preparing claims letters for customers and keeping agents updated about claim status/results.
- Quality Assurance: Monitoring and auditing claim handling processes to maintain accuracy and efficiency, including conducting audits, providing feedback to leaders, and implementing improvements.
- Customer Service: Addressing inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders.
- Provider Relationship: Ensuring smooth operations between the HC team and providers daily when dealing with direct billing.
2. Direct Billing claim handling (20%)
- Supporting or handling cashless claims in case of high volume of claims following manager directions.
- Backing up the assessor, who is responsible for the direct billing hotline, in case of their absence.
JOB REQUIREMENTS
- Education – University Graduate.
- Experience – At least 3 years of experience in medical claim at an insurance company.
- Certifications/licenses – LOMA certificate.
- Good communication and interpersonal skills, decision‑making skill, management skill, and planning skill.
- Medical background is preferred.
- Customer Service Mindset.
- Good English speaking and writing.
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.
You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.
Yêu cầu kinh nghiệm
University graduate; at least 3 years of medical claim experience at an insurance company; LOMA certificate; good communication, interpersonal, decision‑making, management, and planning skills; medical background preferred; good English speaking and writing.