Specialist - Claims Payment (direct health claim)
ประกาศจากแหล่งภายนอกคุณสมัครได้โดยตรง — เราจะพาคุณไปยังหน้าสมัครงานของบริษัท ไม่ต้องสมัครสมาชิก ไม่มีคนกลาง ไม่ต้องล็อกอิน ThaiJobz
เกี่ยวกับตำแหน่ง
This position manages end-to-end health claims processing, from registration and documentation verification to policy assessment and payment approval, ensuring accuracy and compliance. The role requires direct hands-on experience in claims assessment and payment, with a focus on delivering high standards of customer service.
รายละเอียดงาน
Job Summary
The position is responsible for managing end-to-end claims processing, including registering claims, verifying documentation, assessing policy coverage, and approving claim payments within assigned authority. The role requires direct hands-on experience in claims assessment and payment, ensuring accuracy, compliance, and a high standard of customer service throughout the claims journey.
Key Responsibilities
- Register and open claim cases received from members and healthcare providers
- Verify completeness and accuracy of claim documentation in accordance with company standards
- Assess policy coverage, benefit entitlements, and claim eligibility based on policy terms and conditions
- Approve claim payments within delegated authority limits using professional judgment and experience
- Coordinate with internal stakeholders (e.g., Underwriting, Provider Network) and external parties (hospitals, service providers) to obtain required information
- Ensure all claim records and processing activities are accurately captured in the Claims Management System in a timely manner
- Communicate claim status updates clearly and professionally to customers and providers
- Support quality assurance activities and contribute to continuous improvement initiatives within claims operations
- Perform other duties as assigned
Qualifications
- Bachelor’s degree in public health, Medical Technology, or related fields
- Background in the insurance industry is preferred
- Minimum 2 years of direct experience in claims registration, assessment, or related claims functions
- Proven capability to handle claims processing independently and accurately within defined authority limits
Key Competencies
- Strong technical knowledge of claims processes, policy coverage, and benefits
- High attention to detail with strong analytical and problem-solving skills
- Effective communication and stakeholder management abilities
- Ability to work efficiently in a fast-paced operational environment
- Commitment to delivering excellent customer experience
- Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage
คุณสมบัติผู้สมัคร
- ประสบการณ์
- 1-2 ปี
- การศึกษา
- ปริญญาตรี