Claims Services

About the role

Join our People Solutions team and play an important role in delivering employee benefits and group health insurance services to our corporate clients and their employees.

In this role, you will work closely with clients, insurers, and hospitals to support health insurance claims, provide guidance on employee benefits, analyze claim data and trends, and help improve the overall claims service experience.

Key responsibilities

• Provide claims support and advisory services to corporate clients and their employees regarding group health insurance benefits and claim-related matters.
• Conduct group insurance benefit orientations and explain coverage, claim procedures, exclusions, and related requirements to clients and employees
• Analyze claim data, utilization patterns, and claim trends to identify key issues and provide useful insights for clients and internal teams
• Coordinate with insurance companies, hospitals, and other service providers to resolve claim issues and ensure smooth and timely claim services
• Review and follow up on claim shortfalls, declined claims, and exceptional claim cases, coordinating with relevant parties to clarify coverage and identify appropriate solutions
• Identify opportunities to improve claims-related workflows, service processes, reporting, and operational efficiency
• Prepare claim reports, presentations, and supporting information for client meetings and benefit reviews
• Work closely with Account Management and other People Solutions teams to deliver a high level of service and enhance the overall client and employee experience

Job Qualifications

• Bachelor's degree in Business Administration, Insurance, Healthcare, Nursing, or a related field
• At least 3 years of experience in group health insurance, employee benefits, health claims, insurance claims, or related areas
• Good knowledge of Group Health Insurance, including IPD/OPD benefits, claim assessment, policy coverage, exclusions, and insurer procedures
• Experience in coordinating with insurance companies, hospitals, corporate clients, or healthcare service providers would be an advantage
• Good analytical skills with the ability to work with claim data and identify trends and insights
• Proficient in Microsoft Excel; experience with Power BI or other data visualization tools would be an advantage
• Strong communication, coordination, problem-solving, and negotiation skills
• Service-minded, detail-oriented, and able to manage multiple cases and stakeholders effectively
• Good command of Thai and English