Position Objective:
- Provide technical aspect of coaching and guidance to claims team.
- Monitor to ensure daily and monthly KPI is met for team and department.
- Handle complaint, dispute and/or litigation claim case.
- Involve in projects and initiatives relating to process improvement.
Roles and Responsibilities:
- Responsible for the targets and deliverables of Team KPI as defined in the Goal Setting.
- Review / approve claims within approval authority, in compliance with provisions and guidelines, recommend to higher authority for claims exceeding approval limit.
- Pending Claims & Suspense account Management – to ensure ratio meet or exceed target set.
- Handling correspondence with regulator and lawyer for complaint, dispute and/or litigated cases. Signing insurance coverage cancellation and claim rejection letter.
- Support new products launching and work with business analyst team to review product specification, user requirement, test script, etc..
- Conduct roadshow, workshop for sales team.
- Review processes and system enhancement for operational efficiency and effectiveness, increase productivity and improve TAT (turnaround time).
- Conduct self-audit review and dealing with external / internal auditor to provide requirements.
- Staff coaching, guidance and training for skill / knowledge growth and development.
- Prepare active operations management report: daily performance, weekly forecast etc..
Minimum Job Requirements:
- Education – Degree in Medicine, Bioscience, Life Sciences, or other discipline which is relevant.
- Experience – more than 7 years working experience in life claims processing field.
- Sound knowledge in life claims assessment, requirements, procedures, and processing including Financial Services Act, etc..
- Language skills – Good writing, communication, interpersonal and presentation skills. Able to speak and write English and Bahasa Malaysia; Mandarin would be an advantage.
- Microsoft Office Software skills – sound knowledge in applying Word, Excel and Power Point.
