Senior Officer, Medical Service

FIND YOUR 'BETTER' AT Blue Cross

If you believe in better, we’d love to hear from you.

About the Role

• Assess and settle group health insurance claims arising from policies in force
• Make recommendations on policies and guidelines to group health insurance claims
• Liaise with solicitors and other third parties during investigation and negotiation to seek guidance on the course of action that serves the best interest of AIA
• Process all group health insurance claims documents timely
• Answer inquires relating to claims processing

Responsibilities:

• Handle enquires from internal & external customers, provide solutions and information within standard turnaround time

• Manage dispute and complaint related to network service in accordance with the established procedures and guidelines

• Maintain update of network system and its administration

• Collaborate with operation teammates to ensure requests or enquiries being addressed in professional way.

• Identify and investigate suspicious / fraudulent claims including escalation to superior(s)

• Assist in system enhancement and workflow revision to meet our customers’ needs and services standards

• Backup other teams in reaching Company’s services standard;

• Handle ad-hoc duties as assigned by superior(s)

Job Requirements:

• Diploma holder or above in any disciplines

• Minimum 5 years relevant experience in medical claims, customer services or complaint management

• Professional qualification in FLMI, FLHC, etc. will be an advantage

• Familiar with operation of medical claims and healthcare network providers

• Good communication and interpersonal skills

• Detail-minded with strong sense of responsibilities and well-organized

• Flexible and customer-oriented

• Able to handle multi-task and work under pressure in a fast paced environment

• Good command of both written and spoken English and Chinese

• Proficient in MS Office and Chinese Word Processing