Claims Assessor, Medical & Group Benefits

About the role

Parkview Life's Health Claims Service Centre in Kowloon Bay handles medical, hospitalisation and group benefit claims for around 190,000 covered lives. Two-thirds arrive digitally now, which means the work has shifted from data entry towards judgement: is this treatment covered, is the pre-existing condition exclusion engaged, and does this bill look like the procedure described?

We are adding three assessors to the medical team ahead of the group renewal season. This is a genuine entry point into insurance — most of our senior assessors and two of our current team leaders started in this exact seat — and the six-week structured induction assumes you know nothing about claims on day one.

It is honest work with a clear tempo. Our published service standard is five working days for a straightforward hospitalisation claim, and the team hits it because escalation is encouraged rather than treated as failure.

What you'll do

• Assess medical and hospitalisation claims against policy terms, benefit schedules and exclusions
• Review medical reports, bills and pre-authorisation requests, requesting further information where the file does not stand up
• Handle member and HR enquiries by phone and email in Cantonese and English, explaining decisions in plain language
• Identify claims that need clinical or investigation referral and escalate with a clear summary
• Keep your own turnaround and quality figures visible to the team — everyone's are on the same board

What we're looking for

• Higher diploma or above, or HKDSE with at least one year of claims, customer service or clinical administrative experience
• IIQE Paper 1 and Paper 3, or willingness to sit both within six months (fees sponsored)
• Native Cantonese and business English; Mandarin useful for members based across the boundary
• Accurate under volume — the difference between HK$4,800 and HK$48,000 is one keystroke

Nice to have

• Background in nursing, allied health or a clinic front office
• Familiarity with Hong Kong private hospital billing formats
• Experience with a claims workflow system

What you get

• Structured six-week induction and a buddy for your first three months
• IIQE examination fees and study materials fully sponsored
• Medical and dental cover for you and your spouse
• Five-day week with no weekend rota, and overtime paid rather than absorbed
• Kowloon Bay office two minutes from the MTR exit