Claims Processing
→
Process Improvement
Turning operational challenges into structured, data-driven solutions.
Claims Processing Overview
End-to-End Claims verification
Managed end-to-end claims verification across two nationwide government healthcare programmes, each with distinct eligibility criteria, reimbursement policies, and operational workflows.
Claim Received
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Document Verification
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Validation & Assessment
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Resolution & Payment
01 | Main Task
Claims Adjudicator
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Reviewed submitted claims and supporting documents.
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Verified eligibility against programme policies.
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Assessed reimbursement requirements and supporting evidence.
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Identified discrepancies and claims requiring further action.
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Coordinated claim resolution prior to payment processing.
02 | Programme-specific responsibilities
PeKa B40 - Health Screenings, Health Items and Transport Incentives
- Validated claims aligned with clinical indications, approved items, and pricing criteria.
- Verified vendor and item compliance with MDA registration, licensing, and program requirements.
- Verified item delivery against hospital-confirmed delivery orders, cross-checked invoices for item and price variances, and assessed changes against SOP-defined approval criteria.
Hospital Outsourcing Programme (HSOP) - Healthcare Services
Initial Role - Claims Processing
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Reviewed medical reports to verify clinical indications
and procedural completeness, ensuring service quality.
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Ensured procedures complied with programme reimbursement
requirements before claim approval.
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Assessed claims against defined criteria and escalated
exceptions requiring management review.
↓
Expanded Role - Monitoring PIC
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Assigned as the monitoring PIC after gaining experience
in claims processing.
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Monitored claim volume, processing status, and outstanding
issues to support daily operational oversight.
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Identified recurring issues and escalated operational
exceptions requiring follow-up or management attention.
03 | Process Analysis & Improvement
PeKa B40 - Health Screenings, Health Items and Transport Incentives
Operational Workflow
1. Claims Submission & Vendor Selection
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2. Vendor Registration & Compliance
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3. Letter of Award (LOA)
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4. Delivery & Payment Verification
Challenge - New Requirements for Vendor Registration
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Implementation of new SOP requirements introduced
additional supporting documents that needed to be
submitted and verified during the vendor registration
process.
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As verification was performed at the individual claim
level, vendors were required to provide the same
supporting documents repeatedly across multiple claims.
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Incomplete or inconsistent documentation could affect
multiple claims from the same vendor, resulting in
claims being placed on hold and contributing to
processing delays and backlog.
Action Taken
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Enhanced the vendor verification workflow by
introducing an Approved Vendor List (AVL) to
centralise verified vendor information and
supporting documentation.
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Utilised the AVL as a reference during claim
processing to streamline vendor verification
and reduce repetitive documentation checks.
Achievement
1,000+
→
<200
Claims Backlog
Within 2 Weeks
04 | Workflow Enhancement - OCR-Assisted Document Verification
Document Standardisation & Workflow Redesign
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Analysed document patterns across Delivery Orders, Invoices, and
Quotations to establish standardised formats for system-based
data extraction and verification.
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Liaised with the Procurement team to incorporate relevant legal
terms and conditions into the standardised document format,
ensuring alignment with SOP requirements.
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Collaborated with the IT team to identify OCR limitations,
particularly in processing handwritten information, and assessed
potential data discrepancies through analysis of scanned backend data.
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What began as an OCR-assisted document verification
initiative was expanded into a broader Health Aid
workflow revamp, introducing vendor pre-registration
and centralised document management.
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Supported the broader workflow revamp by structuring vendor and
document data for pre-registration, enabling centralised document
storage and reducing repetitive document uploads across claims.
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Supported system data structuring to facilitate automated document
validity tracking and notifications for upcoming document expiry.
Confidential operational details have been generalised.
Skills Developed
Claims Processing
Root Cause Analysis
Process Improvement
Data Validation
Workflow Optimisation
Automation
Operational Analytics