Claims Manager (with Medical Background)

Role purpose:
The role is designed to oversee all activities of Claims Section to run the daily operation smoothly in delivering excellent judgment, prompt and accurate claim assessment to customers and compliance with the company’s strategies to ensure the reputation.
Key Accountabilities:
• Setting overall functional Claims objectives and directions, building Claims guidelines and procedures for all business channels to push expertise for prompt and accurate assessment and excellent service.
• Proposing, initiating and managing operations of nationwide Claims team to ensure Claims team’s activities smoothly executed in accordance with the Company principle and guidelines; monitoring quality and productivity of Claims staff (including of investigator) to ensure fast and accurate assessment as Claims guidelines and cost efficiency.
• Approving claims as per prescribed authority limits; resolving complex claims and/ or developing recommended solutions based on good judgment, initiative and technical skills as Claim Committee member.
• Manage Healthcare to ensure the effective result including manage TPA’s performance.
• Build processes/ procedures to develop system to manage claims daily activities effectively.
• Contributing towards Claims development strategic and annual review planning under the Claims Officer Development Program, deploying strategy and various action plans such as training program, Annual Case review to ensure that they fulfil their works effectively and build a leading and professional Claims team.
• Building Claim operational budget and control claim costs effectively;
• Responsible for Claims reports and updating claims trends to Claims Committee and Management Board.
• Managing FA’s/ customer’s complaints/ enquiries/ relating to Claims. Review appeal claims, make final decision and co-operate with CS department in response to clients or propose solution for senior management approval.
• Cooperating with Actuary/ MKT department in product development and comment on policy term & condition.
• Cooperating with Distribution department in training the FA of claims process/procedure, claims document requirements, held Q & A meetings to clarify FA’s vagueness related to claims, update regulatory the trend of non-disclosure claims to Sales Managers and Underwriting Department for proactive actions.
• Co-operating with reinsurer(s) to effectively perform the reinsurance treaty (ies), handling reinsured claims cases and to organize training course/ workshop with the participation of reinsurer(s).
• Building and maintaining excellent relationship with hospital, clinic networks and government offices, managing the hospital/ clinic and TPA/ partner networks to provide excellent and effective service to customers in Group Employee Benefit Business. Maintain good relationship with other Departments such as CS, Underwriting, IT, Distribution... etc. to smoothly solve all claims-related issues and reach claims objectives.
• Duties to support Division targets and Company objectives as and when assigned.

- 13th Salary + KPI Bonus - Personal Health & Accident Insurance - 18 days of paid annual leave