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Manager - Medical Claims
Great Eastern
Singapore, KSA
Full Time
Manager
3 weeks ago
Claims AssessmentMedical TerminologyICD/CPT CodesAnalytical SkillsCustomer ServiceCommunication
Free
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Claims AssessmentMedical TerminologyICD/CPT Codes
About the Role
Great Eastern is seeking a Manager for Medical Claims to assess integrated shield claims, manage investigations, and drive service excellence. The role requires at least 5 years of claims processing experience, strong medical knowledge, and analytical skills.
Key Skills for This Role
Claims AssessmentMedical TerminologyICD/CPT CodesAnalytical SkillsCustomer ServiceCommunication
Responsibilities
- Assess integrated shield claims and appeals accurately within service standards
- Manage claim investigations and appeals, reviewing medical documentation and policy terms
- Conduct review of pending claims to ensure reserve adequacy and timely closure
- Identify claim patterns and recommend improvements to strengthen controls
- Collaborate with medical institutions, policyholders, and internal stakeholders
- Participate in claims process reviews, system enhancements, and service excellence initiatives
Requirements
- Bachelor's degree or Professional Insurance Certificate or related insurance/healthcare discipline
- At least 5 years of relevant claims processing experience
- Strong grasp of medical practices, terminology, ICD/CPT codes, and insurance policy terms
- Strong analytical skills with ability to interpret complex medical data
- Detail oriented with proven track record of managing high processing volumes
- Customer focused and excellent at building relationships
Full Job Posting
Job Overview
- Are you passionate about making a meaningful impact in healthcare insurance space? At Great Eastern, we’re redefining what it means to be a claim professional.
- Join a passionate team where your medical knowledge, analytical skills, and attention to detail will directly impact the lives of our customers and the future of health insurance.
Key Responsibilities
- Assess integrated shield claims and appeals accurately and within established service standards.
- Manage claim investigations and appeals, including reviewing medical documentation and policy terms.
- Conduct review of pending claim to ensure reserve adequacy and closure of claims in a timely manner.
- Identify claim patterns and unusual or inappropriate practices and recommend improvements.
- Collaborate with medical institutions, policyholders, and internal stakeholders to gather clinical information.
- Deliver accurate and timely assessment of medical claims, ensuring fair payouts.
- Participate in claims process reviews, system enhancements, and service excellence initiatives.
- Adhere to internal policies and external regulatory requirements.
Qualifications
- Bachelor’s degree or Professional Insurance Certificate or a related insurance or healthcare discipline.
- At least 5 years of experience in relevant claims processing experience.
- Strong grasp of medical practices, terminology, ICD/CPT codes, and insurance policy terms.
- Strong analytical skills with ability to interpret complex medical data, spot trends, and make sound decisions under pressure.
- Detail oriented with a proven track record of managing high processing volumes without compromising quality.
- Customer focused and excellent at building relationships with stakeholders.
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