Senior Claims Administrator (LOG)

For over 30 years, APRIL International has specialised in providing innovative international health insurance solutions. We design, distribute, and manage insurance plans and assistance services for individuals and businesses worldwide. With teams operating across Asia, Europe, and the Americas, we are committed to ensuring our members have access to the best care, no matter where they are.

As part of the APRIL Group, an insurance specialist with 3,000 staff members in 20 countries, we are dedicated to simplifying insurance and delivering exceptional customer experiences.

To sustain the company's growth and expand our services, we are currently looking for a Senior Claims Administrator (LOG).

The Senior Claims Administrator (LOG) is responsible for the end-to-end management of pre-authorization and Letter of Guarantee (LOG) requests. This role to review that all medical admissions and procedures align with policy terms and conditions. Ensure accurate coverage decision and cost containment. As a senior member of the team, you will handle complex medical cases, negotiate with healthcare providers, and ensure all stakeholders (members, brokers, and medical facilities) are kept timely informed.

Key Responsibilities:

Review and assess pre-authorization and Letter of Guarantee (LOG/GOP) requests to ensure alignment with policy terms and conditions.

Evaluate medical information, treatment plans, and cost estimates to determine coverage eligibility.

Negotiate with healthcare providers to secure preferential rates

Ensure timely and accurate communication with hospitals, members, brokers, and internal teams regarding case status and decisions including inbound and outbound calls, fax and email.

Monitor ongoing cases and provide updates to all relevant parties throughout the admission or treatment process.

Identify potential risks such as non-disclosure, policy exclusions, or overutilization of benefits.

Coordinate with medical advisors and underwriting teams when additional review or clarification is required.

Ensure all documentation and decisions are properly recorded in the system in compliance with company standards.

Finalize cases, ensuring completeness, accuracy, and proper closure within service level agreements (SLAs).

Handle more complex or sensitive cases. Take ownership of cases requiring advanced knowledge, deeper analysis, or cross-team coordination.

Assist in reviewing cases handled by junior staff by provide guidance, quality checks, and feedback to ensure accuracy and adherence to processes.

Qualifications:

University degree in medical discipline is a strong plus

Excellent command of the English, Cantonese language. Mandarin would also be an asset for the role. 

Proficient in using computers, Microsoft Office, Internet, and E-mail

5+ years of experience in  letter of guarantee (LOG)/preauthorization issuance or claims processing in medical/life insurance

Able to analyze and interpret medical information, product features, research data, and synthesize information.

Able to adapt and work well in a multi-cultural environment.

Excellent communication skills both spoken and written

Flexible and able to multitask effectively in a fast-paced environment

Strong time management and organizational skills

IIQE Paper 1 & 2 certified, or willing to obtain certification within 3 months of joining

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