Job Summary
As a Claim Operation Specialist, you will lead projects and deliver central claims support across life and health products, driving operational excellence through product reviews, system enhancements, governance, and continuous improvement initiatives. You will collaborate closely with claim processing teams and cross-functional stakeholders to meet operational targets and enhance claims management.
Responsibilities
- Lead comprehensive reviews of life and medical product contracts and specifications to define system change requirements and coordinate inputs from cross-functional teams
- Participate actively in product implementation workgroups, collaborating with internal and external partners to ensure seamless deployment of claim products
- Serve as a Claim Subject Matter Expert, translating business requirements into functional specifications by liaising between Claim Business and Business/Technical Analysts
- Prioritize system enhancements with Business Analysts and IT teams to optimize claims processing capabilities
- Manage production issue resolution, including data patches, configuration changes, and testing to maintain system integrity
- Gather and review ongoing requirements, assessing impact and process changes related to system updates from a claim business user perspective
- Communicate and brief stakeholders on the implications of system, product, and benefit changes to ensure alignment and transparency
- Oversee governance by managing work instructions and documentation control to uphold compliance and operational standards
- Conduct claim peer reviews and inspections to ensure accuracy and adherence to best practices
- Lead and contribute to operational efficiency projects aimed at streamlining claims processes and improving service delivery
- Support compliance reporting, exception monitoring, financial tracking, and strategic planning within claims management
- Build and maintain effective relationships with financial consultants, advisers, brokers, and internal departments to facilitate smooth claims operations
- Engage with reinsurers, auditors, and external stakeholders such as CPF Board, hospitals, clinics, and nursing homes during claims administration and audits
- Organize and conduct claims workshops for financial advisors to enhance knowledge and compliance
- Undertake additional projects and administrative duties as assigned by the Section Manager or Head of Function
