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