Claim Ops Specialist

Responsibilities:

. Product Review (Medical and Life Plans)

o Perform Review of Contract and Product Specification, including providing requirements for system changes, coordinating/solicit teams inputs, workgroup discussions on medical and life claims.

o Be part of the product implementation workgroup and have opportunity work with various internal and/or external parties.

. System Support

o Serves as a Claim Subject Matter Expert, as a liaison and reference point between Claim Business and the Business Analyst (BA)/Technical analyst, ensuring that the business requirement are translated to functional requirements

o Conduct prioritization with BA and IT on system enhancements

o Support all production issues, rectifications, data patches/configuration changes or tasks that requires some testing etc. o Involved in ongoing requirement gatherings

o Review impact/process changes due to system changes

o UREQ/BSD review from claim business user perspective

. Engagement, communication & briefing to stakeholders on impact areas in relation to system/product/benefit changes

. Governance

o Management of work instructions and documentation control

o Ensure governance and due diligence over claim processes and services engaged by Claims Section

. Perform claim peer review inspection

. Review and suggest process improvements for developing or implementing best practices. Lead and participate in operation efficiency projects to bring efficiency to claims processes

. Support the Claims team in any compliance reporting, monitoring/reporting of exceptions, claim financial tracking, planning, and strategizing of claims management and other related duties

. Work closely and maintain good rapport with representatives (financial consultants, advisers, brokers, etc.), officers and staff of other departments to carry out his/her work effectively

. Communicate effectively with reinsurers, auditors and external stakeholders such as the CPF Board, and hospitals, clinics, nursing homes in the course of claims administration or audits

. Conduct Claims Workshops to financial advisors when the need arises

. Undertake any projects or duties, including administrative duties, as assigned by Section Manager or Head of Function

Qualifications:

. Diploma/Degree holder with five or more years of experience in Life Claims

. Strong background in Life & Integrated Shield claim processes

. Strong policy language skills enabling accurate and consistent policy wording interpretation

. Strong critical thinking skills and ability to handle complex computations

. Strong written and communication skills, committed team player

. Ability to work under pressure and manage deadlines

. Meticulous with good analytical, organisational skills

. Able to multi-task and work independently

. Customer centric