Tuyển dụng Assistant Manager / Manager, Claim Assessment tại Hồ Chí Minh

Job Purpose

Be responsible for providing medical expertise in the assessment, evaluation, and adjudication of health and life insurance claims. This role ensures that claim decisions are medically sound, compliant with company policies, and aligned with TnC. The doctor works closely with Claims Assessors, Underwriting, and external medical providers to ensure fair and timely claim resolution.

Key Responsibilities

• Lead and oversee the assessment of life and health insurance claims, ensuring decisions are medically sound, consistent, and compliant with company policies and regulatory requirements.
• Provide expert medical interpretation and analysis of medical records, diagnostic reports, treatment history, and physician statements to support claim decisions.
• Review and approve complex, high-value, and escalated claims cases, particularly those involving critical illnesses, disabilities, pre-existing conditions, and contested claims.
• Partner closely with Underwriting on claim investigations and re-underwriting assessments where medical and risk considerations are required.
• Act as the subject matter expert (SME) for medical and clinical matters within the Claims function.
• Coach, train, and develop claims assessors on medical knowledge, claim assessment techniques, and emerging medical trends.
• Handle escalated complaints and disputes related to claim decisions and provide clear medical rationale to internal and external stakeholders.
• Monitor claims experience, identify medical and fraud-related risks, and recommend process improvements to enhance claim quality and efficiency.
• Establish and maintain assessment guidelines, medical protocols, and quality standards for the Claims team.
• Prepare claims analytics, medical trend analyses, and management reports to support business decision-making.
• Lead departmental projects and perform other responsibilities assigned by management to achieve departmental and company objectives.
• Training & Advisory
   - Conduct training for Claims staff on medical terminology, common diseases, and treatment protocols.
   -  Advise OPS management on medical cost trends, fraud patterns, and opportunities for process improvement.
•   Quality & Compliance
  -  Ensure claim assessments comply with internal policies, insurance regulations, and medical standards.
  -   Participate in audits and quality reviews related to medical claims.
   

Yêu cầu ứng viên

• Bachelor's degree in Medicine (MD), General Medicine, Pharmacy, or other healthcare-related disciplines.
• Strong knowledge of medical terminology, disease diagnosis, treatment protocols, and clinical interpretation.
• Extensive experience in claims assessment, underwriting, clinical review, or insurance medical management.
• Proven people management and coaching experience.
• Strong analytical, decision-making, stakeholder management, and communication skills.

Quyền lợi được hưởng

What can we offer you?

· A competitive salary and benefits packages.

· A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.

· A focus on growing your career path with us.

· Flexible work policies and strong work-life balance.

· Professional development and leadership opportunities.

Our commitment to you

· Values-first culture
We lead with our Values every day and bring them to life together.

· Boundless opportunity
We create opportunities to learn and grow at every stage of your career.

· Continuous innovation
We invite you to help redefine the future of financial services.

· Delivering the promise of Diversity, Equity and Inclusion
We foster an inclusive workplace where everyone thrives.

Championing Corporate Citizenship
We build a business that benefits all stakeholders and has a positive social and environmental impact