Position Objective:

The claims analyst is responsible for determining the validity and authorizing settlement of insurance claims, and for the daily operations of all Claims related functions which includes among others after sales service, managing all the incoming and out-going calls to ensure customers are always impressed with our services.
This position is operationally responsible for ensuring the day-to-day Claims and Heath Care services are processed within the guideline, standard and in timely manner. 
He/she is to ensure all customer complaints are handled and resolved speedily to improve processes and communications. 
He/she is to ensure successful deliveries of the BAU activities with quality and follow the internal and external regulatory guidelines and requirements.

Roles and Responsibilities:

• Assess and settle insurance claims arising from policies in force and answer inquiries relating to claims processing and payment
• Process all insurance claims documents timely and make recommendations and guidelines to insurance claims
• To ensure cases are follow-up and follow through within the service standard
• To consult and to seek 2nd opinion from the supervisor and or colleagues for advice before making any business decision that is not cleared
• To carry out day to day transactions and approve based on the approved authority limits
• To perform data entry and or amendments as and when required
• To prepare daily statistics within the agreed timeline and ensure cases are managed by the respective team member for closure.
• To update SOP (STANDARD OPERATING PROCEDURE) and ensure the updated is reviewed by the authorized parties timely
• To support all team members and testing for system enhancements as and when required
• To conduct Training, Learning and SME knowledge Sharing to team members or other department in areas of expertise
• Work closely with the underwriters and New Business to help improve claims experience
• Actively participate in and contribute to projects and initiatives and support all new projects of operations including customer care and system enhancements
• Determine eligible benefits based on documents submitted and policy provisions
• Adjudicate claims and determine corresponding recommendation or decision within prescribed approval limits and within the defined turnaround time
• Assist the Team in resolving claims-related complaints/issues and/or concerns
• Discuss claim decisions with Management whenever necessary

• Preferably bachelor’s degree holder related to any medical course
• Strong ability of understanding medical terminologies in analyzing and reviewing medical cases
• Good team player with strong analytical, interpersonal and communication skills and ability to work under pressure
• Able to handle conflicts and self-motivated in difficult situations with good customer service orientation
• Proficient in Microsoft Office tools (i.e., Teams, Outlook, One Drive, Excel, Word, and PowerPoint)
• Displays high learning orientation, innovation, and motivation to achieve target goals
• Knowledge in claims processing is a plus
• Literacy in both English and Burmese, both verbal & written