Provide supports to team in handling fax claims received from hospitals, investigates and makes decision for claims in the system. In addition, continuously monitors and makes decision for the pending cases of fax claims, or back log.

Key Responsibilities

Hospital Fax Claims

- Provide supports to team in handling the fax claims from the hospital
- Check the information from fax claims documents, and record into the system
- Investigate and make decision for claims in the system, by covering the below actions:
- Approve for the payment base on authorization
- Perform rejection of fax claims received Require the additional information Issue memo into the system for administration in performing next steps
- Submit for further investigation
- Request the hospital records from hospital
- Continuously monitor and make decision for the pending cases of Claims Hospital Fax, or back log

Hospital assessment Claims (OPD cashless)

- Provide support team in handling the OPD cashless claims from the hospital
- Perform investigation and make decision for OPD cashless claims received in the system
- Approve for the payment base on authorization
- Perform rejection of fax claims received
- Require the additional information
- Issue memo into the system for administration in performing next steps
- Submit for further investigation
- Request the hospital records from hospital
- Continuously monitor and make decision for the pending cases of OPD cashless Claims Hospital or back log

Consolidate/manage the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization
Report- Collect the information, and support Manager - Claims Hospital Fax in providing the daily and monthly reports regarding to volume and turnaround time of Claims Hospital Fax
Give consult / advise medical related to jr. claim assessor or others

Must Have

Bachelor’s or master’s degree in business administration, Nursing, Business of Sciences (Medical Technology), or other related field
At least 2 yrs of experience in Claims assessor, or other related fields in insurance industry
Accuracy concern & detail orientation
Experience in using claims/CRM systems
Ability to prioritize claim related functions
Knowledge of MS Office, Excel, PowerPoint or data software Power BI will be advantage
Strong leadership/supervision skills
Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage

1 Job im Bereich Cashless Claims Handling in Thailand

Specialist - AZAY Claim Hospital Fax