Claim Assessment Senior Specialist (Chuyên viên Cấp cao Dịch vụ Thẩm định Bồi thường)
Core
Senior specialist adjudicating healthcare claims (reimbursement and direct billing), assessing medical necessity, and ensuring risk control within Prudential's quality framework.
Role type
Senior IC claims adjudicator (healthcare)
Builds
Accurate claims decisions and payment calculations for healthcare providers and customers
Domain
Insurance / Healthcare
Required skills
Healthcare claims adjudication, audit of insurance/hospital claims, medical necessity assessment, policy provisions knowledge, MS Excel/Word/PowerPoint, customer service in claims
Preferred skills
Experience in healthcare claims department or hospital environment, innovative/creative approach, self-assured and results oriented
Responsibilities
Process daily claims volume within SLA and quality standards, review complex or referred cases, perform monthly audits on claims cases, communicate with customers/hospitals for clarification, prepare case studies on policy coverage or exceptional handling proposals, rectify incorrect processing or decisions
Seniority
Senior, hands-on IC
