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Job Purpose You will be handling insurance claims assessment under the accident and health plans. You will also be given the opportunity to be part of an exciting team with involvement in service excellence initiatives and projects to improve the claims experience.
Determine policy coverage, establish proof of loss with proper documentation and provide accurate and timely assessment of accident and health claims within the required service standards and ensure that claims are paid accurately and promptly;
Handle claim investigation and appeals;
Build collaborative relationships with and ensure that claims are well managed for both internal and external key stakeholders (i.e policyholders, beneficiaries, distribution servicing rep, medical institutions) to achieve claims business objectives;
Attend to claims enquiries;
Suggest and participate in process improvement projects/ initiatives/ system enhancement, including establish claims best practices;
Ensure compliance with internal and external regulatory and legal matter;
Conduct review of pending claim to ensure reserve adequacy and closure of claims in a timely manner;
Guide and mentor junior staff;
Take accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks;
Maintain awareness of industry trends on regulatory compliance, emerging threats and appropriate steps to mitigate the risks; and
Highlight any potential concerns/risks and proactively shares best risk management practices.