Specialist, Assessment Claims
Manulife — Dist.7, Ho Chi Minh
Posted 2026-10-23
Position Responsibilities 1. Reimbursement Responsibilities Review and assess reimbursement claim submissions to ensure accuracy and compliance with policy guidelines. Validate supporting documents such as invoices, medical records, and prescriptions. Calculate eligible reimbursement amounts and identify exclusions or non-covered items. Escalate suspicious or high‑risk claims following fraud detection protocols. Maintain accurate documentation and ensure adherence to SLA/TAT requirements. 2. Direct Billing Responsibilities Handle direct billing requests from hospitals and clinics, verifying eligibility and benefit coverage. Review and approve pre‑authorization for medical services based on policy rules and medical necessity. Communicate with providers to clarify treatment plans and negotiate cost adjustments when required. Monitor inpatient cases to control medical expenses and prevent misuse. Record decisions in the system and coordinate with back‑office teams for settlement. Required Qualifications 2–3 years of experience in healthcare claims assessment, reimbursement, or direct billing. Basic knowledge of medical services, insurance benefits, and medical terminology. College or