Aetna Health Insurance (Thailand) Public Company Limited.

IPMI Claims Assessor

Aetna Health Insurance (Thailand) Public Company Limited.
เงินเดือนสามารถต่อรองได้
ลงประกาศเมื่อ 17 Nov 2020

IPMI Claims Assessor

Aetna Health Insurance (Thailand) Public Company Limited.

ไฮไลท์เด่นของงาน

  • 3 years of experience in claims assessment
  • Good command in English skills
  • Strong planning and time management skills

รายละเอียดงาน

Job Purpose

  • To assess member and provider claims in line with the each client’s insurance policy in a timely manner
  • To work in a positive, cooperative manner with Claims Nurses, and claims admin staff to deliver excellent service for our IPMI customers.
  • To deliver excellent operational performance against agreed KPIs

Responsibilities

  • To work closely with claims admin and claims nurses with an aim to assess claims accurately in line with terms and conditions of the IPMI product
  • To investigate and provide solutions to customer queries by researching all possible alternatives.
  • To proactively raise blockers to their line manager which are stopping us improving claims assessment
  • To ensure all interactions related to any case are promptly and accurately recorded on appropriate systems and communicated to the member.
  • To assess claims eligibility in line with regulatory requirements.
  • Where necessary, to proactively liaise with providers to obtain correct up to date information before assessing the claim.
  • Continually look for ways to improve the service we provide for our members and corporate clients.
  • To support Customer Service teams with claims related complaint investigation and resolution. 
  • To utilize existing technology and to be a competent user of all systems used within the member service and claims environment.
  • To proactively highlight improvement opportunities to contribute to the growth of Aetna Thailand
  • To work in line with defined authority levels for claims payment and sign off
  • To investigate claims for possible abuse and fraud.
  • To escalate complaints, high costs & suspicious fraudulent claims
  • To ensure we are being charged in line with agreed tariffs concerning direct billing claims and alert internal teams of any breaches, any suspicion of potential abuse or fraud.

Qualifications & Technical Skills Required

  • Ability to demonstrate customer led thinking.
  • In depth understating of  members’ needs

Experience Required

  • At least 3 years of experience in claims assessment
  • Good command in English skills

Mandatory Competencies

  • Strong planning and time management skills are essential
  • Change Management skills
  • Analytical skills

Aetna Health Insurance (Thailand) Public Company Limited
98 Sathorn Square Office Tower,
14th-15th Floor, North Sathorn Road,
Silom, Bangrak, Bangkok 10500

รายละเอียดเพิ่มเติม

ระดับตำแหน่งงาน
ระดับเจ้าหน้าที่
ระดับการศึกษา
ไม่ระบุ
อายุงาน
3 ปี
ประเภทการจ้างงาน
งานเต็มเวลา, งานประจำ
เว็บไซต์บริษัท

ข้อมูลบริษัท

About Aetna

Aetna is one of the leading diversified health care benefits companies in the United States, serving an estimated 46.5 million people with information and resources to help them make better informed decisions about their health care.

Aetna Insurance Company organized an annuity fund to sell life insurance in 1850. In 1853, the Annuity department separates from Aetna Insurance and is incorporated as Aetna Life Insurance Company. The company's first president is Eliphalet A. Bulkeley. The "Aetna" name is retained to take advantage of the good reputation of the original Aetna. The name was inspired by an 11,000-foot volcano on the eastern shores of Sicily, Mt. Etna, which was the most active volcano in Europe.

Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

About Aetna International

Aetna International, part of Aetna Inc., is committed to helping create a stronger, healthier global community by delivering comprehensive health care benefits and population health solutions worldwide.  One of the largest providers of international private medical insurance services, Aetna International serves more than 700,000 members worldwide, including expatriates, local nationals and business travelers. Aetna International also offers customized technological and health management solutions for health care systems, government entities and large employers to improve people’s health, enhance quality of care and contain costs. For more information www.aetnainternational.com

About Aetna Thailand

In July 2017 Aetna was established in Thailand Formerly, we known as Bupa Health Insurance (Thailand) Public Company Limited and now we have over 300,000 members and more than 2,000 organizations and over 400 hospital networks. For more information www.aetna.com

ข้อมูลบริษัทเพิ่มเติม

ประเภทธุรกิจ
สวัสดิการและสิ่งจูงใจอื่น ๆ
สิทธิการเบิกค่าทันตกรรม, ทำงานสัปดาห์ละ 5 วัน, มีเวลาการทำงานที่ยืดหยุ่น, ประกันชีวิต, ประกันสุขภาพ, เงินโบนัสตามผลงาน
ประเทศไทย (ภาษาอังกฤษ)