- Handle insurance recoupment and reconciliation works, communicate with providers and members via call and email for collection and explanation
- Follow up on manual claim and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and target on claims adjudication
- Performed insurance claims assessment according to the actual situation
- Review the approved claims to ensure the accuracy and made an adjustment as necessary
- Generate daily claim process and all related document from the system and preparing claims documents to be sent to the payer
- Investigate claims through liaison parties to determine the eligibility of the claims
- Complete all daily call log and daily claim log
- Prepare claim report on a regular basis
- Accountable on daily operations to meet productivity or service standards as defined by management in line with department and/or division
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