Claims Assessor

Essential Job Functions:

• Claims Processing: Handle all medical and extended warranty claims, ensuring they are valid under the policy terms, within policy limits, and assess the circumstances around each claim. Identify opportunities for cost containment and adhere to company service standards and timeframes for processing and finalizing claims.
• Medical Review and Assessment: Conduct medical reviews, follow up on medical information, and assess claims accurately.
• Reporting: Provide Claims Management reports to demonstrate that service standards are being met.
• Emergency Medical Claims Management: Collaborate with the Medical Assistance Coordinator to manage emergency medical claims effectively.
• External Coordination: Work with external providers to ensure claims are managed cost-effectively and within company time standards and expectations.
• Internal Coordination: Communicate with the Travel Insurance Manager to get approval or denial of claims.
• Documentation: Prepare necessary letters and documents in compliance with company service standards.
• Customer Service: Deliver exceptional customer service by answering inquiries professionally, building rapport with customers, and resolving their issues promptly and efficiently.
• Quality Assurance: Maintain high levels of follow-through and service excellence in all interactions with customers and client companies.
• Workload Transparency: Provide honest and fair assessments of workload status to management.
• Claims Accuracy: Ensure that the status of claims handled accurately reflects their true status and that estimates represent the actual or potential claim exposure.
• Reporting to Healthcare Manager: Prepare and submit reports to the Healthcare Manager as required.

Requirements:

• Native Thai speaker
• Bachelor’s degree in any field
• Prior experience in health insurance is advantageous
• Good English skills are required; proficiency in additional languages is highly beneficial
• Proficient with computers, specifically with Word and Excel
• Strong interpersonal skills
• Excellent conceptual, analytical, and problem-solving abilities
• Self-motivated and able to work with minimal supervision
• Ability to work well within a team
• Strong English communication skills in writing, reading, and speaking
• Able to work on weekends and public holidays