Claims Assessor

LUMA's mission is to ensure our members live healthier, longer lives by providing them brilliantly simple insurance plans. We provide a range of simple, smart policies to global residents, expatriates, local nationals and groups of all sizes. At LUMA, we continuously adopt new innovations to make insurance easy to understand and easy to use.

The Claims Assessor, will serve medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.

Responsibilities:

• Manage OPD direct billing (credit), IPD admissions and pre-authorization requests from insured members and healthcare providers across Thailand and Southeast Asia. Issue Letters of Guarantee in accordance with policy eligibility, benefit provisions and medical necessity, and escalate complex or exceptional cases to the Medical Advisory Team for clinical review and coverage determination.
• Review concurrent admission and discharge cases to determine continued medical necessity and appropriate coverage.
• Review hospital bills, medical records, and supporting documents to ensure accurate benefit application and claim adjudication, while maintaining accurate claim documentation, diagnosis coding, and records in the core insurance system in compliance with company policies and service standards.
• Proactively monitor, follow up and resolve claims cases to ensure timely assessment and decision-making.
• Maintain accurate claim documentation, diagnosis coding and records in the core insurance system while ensuring compliance with company policies and service standards.
• Support claims assessment, policy interpretation, and other claims-related activities as assigned.

Qualifications:

• Medical background (Nursing graduate preferred)
• Experience in the healthcare, insurance, or related industry
• Excellent communication skills in both Thai and English
• Strong analytical skills with sound judgment and the ability to prioritize work
• High attention to detail with the ability to work effectively under pressure

Competitive package:

• 12 days of Annual leave per year
• Social Security
• Provident Fund
• Medical Insurance