Claims Assessment, Analyst_Critical Illness

Report to: Manager, Claim Assessment – Critical IllnessLocation: Ho Chi MinhFunction: Customer & Information Technology | Department: Customer OfficeType: Individual ContributorTHE 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.