Aetna Claims Benefit Specialist (Assessor) in Singapore, Singapore
Req ID: 52870BR
Summary/MissionAchieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Position Summary/MissionReviews and adjudicates claims in accordance with claim processing guidelines Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)· Analyzes and approves claims.· Completes work with a limited degree of supervision· Assesses claims up to given Authority limit- lower $ value claims and advice from designated Specialists. (Senior Claim Benefits Specialist and Medical Claim Benefits Specialist colleagues).· Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.· Investigate claims for possible abuse and fraud.· Conducts outreach activities including but not limited to email, member calls, provider calls as part of the claims adjudication process· In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and all systems within specified turn-around-time parameters.· Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., use of all documented resources).· Escalate unresolved claims complaints and high costs claims to the claims supervisor for guidance.· Continually work to improve best practices procedures and standards.· Ensures compliance with requirements of regional compliance authority/industry regulator.· Adheres to international privacy policies, practices and procedures. Background/Experience Desired· 2 years experience in a healthcare claims environment.· Claim assessment experience.· Requires specialized skills in one area or a breadth of knowledge across multiple areas. Education and Certification RequirementsHigh School graduate or local market equivalent. Additional Information (situational competencies, skills, work location requirements, etc.)· Ability to maintain accuracy and production standards.· Analytical skills.· Technical skills.· Excellent communication skills.· Oral and written communication skills.· Understanding of medical terminology.
Job Function: Claim