Claims Analyst is responsible for reviewing, assessing, and adjudicating health insurance claims in accordance with policy provisions, company guidelines, and regulatory requirements. This role ensures claims are processed accurately, fairly, and within established service standards, while maintaining compliance with internal procedures and risk controls.

In addition, the Claims Analyst works closely with customers, healthcare providers, and internal stakeholders to gather and validate claim information, resolve inquiries, and support timely claim resolutions. The role plays a key part in delivering a positive customer experience by balancing efficient claim handling with high standards of quality and service.

Position Responsibilities
- Review and assess health insurance claims submitted by members and healthcare providers.
- Verify the completeness and accuracy of supporting documents, including medical diagnoses, treatment records, investigation results, and medical expenses.
- Validate policy eligibility, benefits, coverage limits, exclusions,



and applicable terms before making claim decisions.
- Determine claim outcomes, including approval, rejection, partial approval, or requests for additional information.
- Identify potential fraud, abuse, or irregular claim activities and escalates cases when necessary.
- Liaise with hospitals, clinics, healthcare providers, brokers, and policyholders to obtain additional information and resolve claim issues.
- Ensure claims are processed within the company's established Service Level Agreements (SLAs).
- Communicate claim decisions professionally and clearly to internal and external stakeholders.
- Ensure compliance with company policies, regulatory requirements, and governance standards.

Required Qualifications
- Bachelor's degree in Medicine, Nursing, or a related healthcare field.
- Experience in health insurance claims, managed care, TPA, or health insurance operations is preferred.
- Strong understanding of medical

📌 Claim Analyst (Asia)
🏢 Manulife Financial
📍 Asia