America's Job Portal
At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.
Sound like you? Then read on.
About the Role
To process complex inpatient and outpatient claims for Group Policyholders and apply strong technical judgment, digital tools, and data driven insights to ensure fair claim outcomes, effective risk and fraud identification, and continuous improvement of claims processes.Independently assess complex claims by applying strong technical judgment, policy interpretation, and medical understanding to ensure fair and accurate claim outcomes.
Leverage digital tools, rules engines, and available automation outputs to enhance assessment efficiency, while exercising human judgment for cases requiring interpretation, exceptions, or escalation.
Analyze medical reports, invoices, and supporting documentation to validate claim eligibility, identify inconsistencies, and determine a...