Senior Executive, Claims-Assessor

Job Summary:  

This position is responsible for handling personal accident and health claims routine task from end to end and apply medical knowledge to ensure that each claim being considered fairly to customer, aligned with insurance policy and medical necessity. 

Responsibilities: 

• Major responsibility of “Reimbursement Claims” booth individual & group policy 

• Processing Accident & Health claims to enable that all steps aligned with SOP and agreed SLAs 

• Review customer claims document and assessing claims to ensure that customer request is eligible and covered by insurance terms & conditions 

• Investigate suspicious medical claims cases and collaborate with internal and external stakeholders 

• Process claims payment to customer, hospital in network on a timely basis  

• Provide customer assistance and handle customer/broker enquiry 

• Responsible for complaint escalated by Customer Service, Marketing or Regulatory (OIC) 

• Review claims process and proposes ideas to improve working process, proactively report process issues that need further enhancement and development, including system UAT 

• Overseeing AH Claim’s customer services to ensure that team delivery best customer experience every touchpoint on each sage of claims 

• Overseeing team and ensure that customer enquiry through email, calls, etc. being handled on timely basis 

• Identify cost savings opportunities before and during the hospitalization claims 

• Negotiate additional saving with network hospital at pre-invoice (IPD) & post-invoice 

• Proactive identify opportunity to steering the case from high-cost facility to preferred provider at reasonable charges 

• Conduct cost containment and ensure that medical treatment done at proper utilization and customary price  

• Handle holiday fax claims service on a roster basis 

Qualifications: 

• Bachelor’s in Nursing or other related medical fields. 

• 5 years of health insurance experience and at least 3 year in claims assessment and processing. 

• Detail orientation, Problem-solving, negotiation, and decision skills. 

• Good communication and interpersonal skills with service attitudes. 

• Self-motivated, independent, and able to work under pressure. 

• Familiar with MS Office applications. 

• Intermediate in written & spoken English.

• Good team player.

• Flexible working hours and enable to work on weekend.

About LMG Insurance Thailand

LMG Insurance in Thailand is a 100% owned subsidiary of the Liberty Mutual Insurance Group. Headquartered in Boston, Liberty Mutual Insurance Group is a diversified global insurer and the fifth largest property and casualty insurer in the U.S based on 2022 gross written premium. It ranks 86th on the Fortune 100 list of largest corporations in the U.S. based on 2021 revenue. As of 31 December 2022, Liberty Mutual Insurance Group had US$50 billion in annual consolidated revenue.

LMG Insurance Public Company Limited previously named Narai International Insurance Co. Ltd.,

The company was established on 27 November 1975. In 2003 the company merged with Kum Klao Insurance Public Co. Ltd. On 6 September 2004, the company registered under the new name of LMG Insurance Company Limited. On 2 July 2012, then the company was listed as a public company - LMG Insurance Public Company Limited.

Our years commitment to offering the highest level of service to our customers has propelled LMG Insurance Public Company Limited into one of the top rank position in the Thai insurance market, with a reputation for trust and reliability that extends countrywide. Its financial stability is unparalleled with about THB 1,700 million in authorized capital and the support of Liberty Mutual Insurance of the USA, one of the world’s leading insurance providers.

We employ over 50,000 people in 29 countries and economies around the world. Every role at Liberty Insurance is essential to our mission of helping people embrace today and confidently pursue tomorrow.

Join us and take the opportunity to advance your career.