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You will be responsible to supervise a team of claim assessors handling processing of medical claims, manage complex and early claim assessment and to ensure that the Section's KPIs are met. Reporting to Section Head of Health Claim Services , you will also be given the opportunity to be part of an exciting team with involvement in customer service initiatives and projects to improve the claims experience and process efficiency.
Supervise and manage a team of claims assessors handling inpatient medical claims to ensure that claims are paid in accordance with the terms and conditions of the policy and the relevant internal procedures;
Handle complex claims, claims appeals and customer care issues;
Regular monitoring over day-to-day operation matters and team productivity;
Drive productivity of the team to ensure the department's KPIs are met;
Build claim assessment competency, medical knowledge and communication skills of a team of claim assessors through coaching, guidance and training. Identify training needs and formulate staff training plans to build competency;
Build collaborative relationships with and ensure that claims are well managed for both internal and external key stakeholders (i.e policyholders, beneficiaries, distribution servicing representatives, medical institutions) to achieve claims business objectives;
Provide claims training to distribution servicing representatives;
Perform analysis on claims data to identify trends and opportunities for process improvement, including establish claims best practices;
Drive, support and implement initiatives to a chieve cost and process efficiency, including service excellence initiatives/system enhancement;
Ensure compliance with internal and external regulatory and legal matter;
Takes accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks;
Maintains awareness of industry trends on regulatory compliance, emerging threats and technologies in order to understand the risk and better safeguard the company;
Highlights any potential concerns /risks and proactively shares best risk management practices; and