Health Claim Manager

Job Description

Oversee the daily operations of health insurance claims processing (cashless and reimbursement).
Ensure claims are assessed, approved, or rejected in accordance with policy terms, underwriting guidelines, and regulatory requirements.
Monitor claim turnaround time (TAT) and ensure service level agreements (SLAs) are met.
Manage relationships with hospitals, clinics, TPAs, and service providers.
Work closely with medical auditors, underwriting, and fraud investigation teams to prevent claim leakages.
Work with customer service teams to improve claims communication and customer satisfaction.

Job Requirements

Bachelor’s degree in insurance, Business Administration, Healthcare Management, or a related field; MBBS qualification is highly preferred.
Minimum 3 years of experience in health insurance claims.
Excellent analytical and decision-making abilities
Good understanding of medical terminology and procedures.
Strong communication and negotiation skills

Department
Operations Planning
Location
Yangon

Experience Level
Experienced
Job Type
Full Time
Education Level
Bachelor
Positions
2 Posts

Department
Operations Planning
Location
Yangon

Experience Level
Experienced
Job Type
Full Time
Education Level
Bachelor
Positions
1 Post

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Choose from the following types of AYA Health Standard Plans to suit your needs!

AYA Health Plus
AYA Health Pro
AYA Health Prestige
AYA Health Prime

We also provide corporate customers with versatile health insurance solutions as Cafeteria Plan, meticulously customized to align perfectly with your unique needs. Regarding the purchase of the Cafeteria Plan, only the rules, regulations, and decisions of AYA SOMPO Insurance Co.,Ltd are considered final.

Table of Benefits (in MMK)	AYA HEALTH
Table of Benefits (in MMK)	PLUS	PRO	PRESTIGE	PRIME
Maximum Benefit PRIME Plan only : Additional Limit of up to 44,000,000 MMK, applies to Thailand Zone	11,000,000	11,000,000	11,000,000	11,000,000
Medical and Hospital Benefits	Benefits up to	Benefits up to	Benefits up to	Benefits up to
Ambulance Services	165,000	165,000	165,000	165,000
Hospitalization Costs Accommodation in a standard single-bedded room and meals: Medical Treatment and services ordered by a Physician, including: Surgeon’s and Anesthetist’s charges Physician, Consultant and Nursing charges Diagnostic Procedures (including CT, MRI and PET scans) Surgical Appliances and Prostheses Medicines, Drugs and Dressings Intensive Care Day-Care	Full Refund	Full Refund	Full Refund	Full Refund
Post-Hospitalization Treatment	Nil	Nil	Nil	Nil
Chronic Conditions
First Onset	11,000,000	11,000,000	11,000,000	11,000,000
Ongoing Management	5,500,000	5,500,000	5,500,000	5,500,000
Maternity Cover (10 Months Waiting Period) Pre-Natal Examinations by a Physician All costs of Normal Childbirth or C-Section (elective or non-elective) Post-Natal Examinations by a Physician	Nil	Nil	Nil	1,100,000
Thailand Zone
Hospitalization Costs	Nil	Nil	Nil	44,000,000
Transportation Costs				2,200,000
Transportation Costs for Treatment not available in the Geographic Area				5,500,000
Additional Deductible for Treatment outside the Geographic Area				55,000
Outpatient Benefits	Benefits up to	Benefits up to	Benefits up to	Benefits up to
Physicians fees, Prescription Drugs and Dressings Specialist and Consultant Fees Diagnostic tests, medical scanning and imagery services	220,000	440,000	660,000	660,000
Optical Care One annual Vision test Glasses Glaucoma Test for Participants over 45 years	Nil	Nil	Nil	220,000
Dental Care Benefits	Benefits up to	Benefits up to	Benefits up to	Benefits up to
Dental Treatment Dental Surgery	Nil	Nil	Nil	220,000
Personal Accident Benefits	Benefits up to	Benefits up to	Benefits up to	Benefits up to
Accidental Death Loss of Sight or Loss of Limb Permanent Total Disablement	11,000,000	11,000,000	11,000,000	11,000,000

Renewal Period	First Year	Second Year Onward
Health Bonus %	10%	5%

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