Claims Assessment, Analyst_Critical Illness

Report to: Manager, Claim Assessment – Critical Illness

Location: Ho Chi Minh

Function: Customer & Information Technology | Department: Customer Office

Type: Individual Contributor

THE OPPORTUNITY:

• Perform claims assessment and decision-making for Critical Illness claims within assigned authority level.

• Handle customer complaints related to claim decisions and support resolution for escalated cases.

• Participate in system enhancement initiatives and ensure compliance with claim procedures and regulations.

ROLES AND RESPONSIBILITIES:

1.Claims Assessment & Decision

• Assess and make decisions on Critical Illness claims within Authority Level B.

• Ensure claim decisions are accurate, fair, and aligned with policy terms and internal guidelines.

• Propose solutions for cases exceeding authority level and escalate appropriately.

2. Customer Complaint Handling

• Handle customer complaints related to claim decisions with professionalism and empathy.

• Coordinate with internal teams to investigate and resolve issues.

• Provide clear explanations and ensure timely resolution to maintain customer satisfaction.

3. System & Process Support

• Participate as a project member in testing new system features and enhancements.

• Learn and update knowledge on claim systems, procedures, and administration processes.

• Ensure compliance with updated claim regulations and procedures.

4. Stakeholder Coordination

• Coordinate with internal departments to process claim cases efficiently.

• Communicate with external parties (e.g., TPAs) to provide or clarify claim-related information.

• Ensure all communications follow company regulations and procedures.

• College or University Degree; Medical or Law degree preferred

• LOMA 280 & 290 certifications will be a plus

• Minimum 2–3 years of experience in claims processing

• Practical knowledge of insurance and claim procedures

• Ability to assess claims and interpret medical/legal documents

• Familiarity with claim systems and digital tools

• Strong communication and customer service skills

• Adaptability and problem-solving mindset

• Team collaboration and responsiveness

• Development opportunities: grow into senior roles & exposure to system development and cross-functional projects