As a Claims Manager, you will manage the claim assessor team for In-processing & Out-processing patient claims. You provide claims technical support as well as monitor the staff KPI. Emphasis is on claims processing Turnaround time as well as the service level agreement. You are responsible for:
- Ensure claims are handled in accordance with the group's guidelines and best practice
- Coordinate complex claims matters with the management and supports risk and claims data analysis and reporting, including data quality control activities within the team
- Create and present various claim reports (large events/losses, monthly/quarter/year end close, data, quality, etc) in close cooperation with Head of Claims
- Manage a small team, drive consistency, process alignment and existing Global Guidelines and best practices
- Oversee all electronic claims processes and evaluate all self-insurance applications and prepare claims reports.
- Analyze all claims and identify all risks and ensure processing of all claims as per company policy.
- Forecast all staffing requirements and identify and resolve all issues effectively and schedule all employee attendance.
- Assist the Head of Claims in the collation of information and its reporting; respond to queries raised by internal and/or external parties in a timely and accurate manner
- Provide training to juniors to manage all outstanding claims and design an efficient duty program and coordinate with HR team to facilitate same.
- Monitor effectiveness of all programs and provide support to all open claim file reviews and manage all payment cycle to ensure compliance to all contract requirements.
- Design and maintain panel of investigators to use all TPA and prepare reports for monthly chargeback for all business units.
- Analyze all claims to ensure optimal quality and prepare reports for various business units and monitor all chargeback expenses and provide report to all clients and management.
- Provide recommendation to improve processes, proficiency and supervise effective resolution of all claim inquiries.
- Schedule and resolve all internal and external audits on all claims issues and supervise processing of all billing issues.
- Ensure all claims are settled accurately, timely and smoothly as per stipulated SLA.
- Provide excellent service turnaround to internal and external stakeholders
- Ensure the claim assessors onshore and offshore are aware of compliance and regulatory requirements
- Update Standard Operating Procedures promptly & ensure report incidents or errors or controls are reported.
- Participate actively in any process enhancements, review of claims guidelines to improve claims standards and at times involve in user acceptance testing on new products, system enhancement and projects.
Job Requirements:
- Candidate must possess at least Bachelor's Degree/Post Graduate Diploma/Professional Degree in any field. Insurance industry certifications is an added advantage.
- At least 6 Year(s) of total working experience in handling various type of claims and 3 years of experience leading a team
- Solid technical claims skills, Strong analytical skills and sound judgement
- Excellent interpersonal communication, to communicate effectively with internal and external stakeholders
- Detailed and well organized
- Customer oriented
- Able to work under pressure and has the ability to think outside the box
We are part of HMI Ltd. By applying for this role, you consent to us sharing your application with entities within the HMI Group.
