Senior Claims Examiner, A&H Claims

Responsibilities

• Assess Group and Individual hospitalisation and surgical claims on a reimbursement basis
• Audit cashless claims for Group and Individual hospitalisation and surgical claims
• Oversee and facilitate payment processing for bordereaux medical claims
• Perform sanctions checks and ensure compliance with internal and external regulatory requirements
• Monitor Third Party Administrator (TPA) performance and proactively resolve issues
• Maintain constant communication with management and underwriting teams
• Provide feedback on visible claims trends and conduct regular reviews of aging files
• Participate in ad hoc projects and tasks as assigned

Requirements

• Proven experience in handling medical-related claims
• Sound knowledge of both medical and claims practices
• Ability to read and interpret medical reports
• Strong attention to detail and accuracy in data entry and document management
• Critical thinking skills to evaluate the authenticity of claims
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
• Effective written and verbal communication skills
• Professional attitude with the ability to handle confidential information with discretion