Claims Executive

Key Responsibilities

Attend to client (HR or employees) enquiries via phone calls and emails in a timely and professional manner, providing support on claims, benefits enquiries, and pre-authorisation matters.

Communicate effectively and maintain excellent service relationships with members/employees regarding the utilisation and management of their insurance policies.

Provide full support to HR, group employees, and/or Key Account Managers in clarifying and investigating claims issues (e.g. delayed, pending, or declined claims), including checking on claims reimbursements.

Manage reasonable claims appeals with insurers, including declined pre-authorisation cases, and explore all possible avenues for resolution.

Process pre-authorisation requests and emergency procedures, liaising with clinics, healthcare providers, and medical practitioners where required.

Handle direct billing and e-claims/online portal/mobile app enquiries and issues for Key Account members, including updating relevant materials, platforms, and employee handbooks.

Liaise with insurers to clarify benefit and policy enquiries relating to claims, coverage, provider networks, and panel clinics.

Maintain claims records accurately and efficiently, ensuring timely and accurate status updates.

Assist Key Account Managers with group presentations, employee orientations, and medical briefings.

Assist in preparing service reports, claims reports, employee handbooks, and other documentation required by Key Account Managers for renewals or client requests.

Support the team in the regular review of insurers' direct billing facilities (e.g. ensuring updated provider lists are received on time, updating client microsites and PCP portals, etc.) and assist members in locating appropriate healthcare providers.

Perform any other ad hoc duties assigned by the Team Leader or Senior Manager.

Requirements:
Diploma holder with

a minimum of 2 years of relevant experience in claims administration or client servicing within the insurance industry.

Insurance certifications such as BCP, PGI, ComGI, and HI will be an advantage.

Customer-focused with strong attention to detail, analytical, and reconciliation skills.

Excellent interpersonal and communication skills

Well-organised and able to work effectively in a fast-paced

Pacific Prime is a leading global insurance advisor and global employee benefits specialist with over 500,000 clients worldwide. With offices across Singapore, Australia, China, Hong Kong, Indonesia, Malaysia, Mexico, Thailand, Philippines, United Arab Emirates, United Kingdom, and United States, we are able to offer a wide range of insurance solutions that transcend global and regional boundaries.

We have close to 1300 employees globally, making us one of the largest intermediaries in Asia’s medical insurance and a leading distributor of International Medical Insurance plans. We arrange all types of insurance services worldwide with a diversified client base that includes both corporations and individuals.