In this role, you will be supporting assigned channels by providing full claims support advisory.
Responsibilities:
- Review and decide on claim settlements and approve within authority limit
- Ensure all enquiries are responded in a timely manner
- Work closely with brokers/corporate clients/OSS on claims matters/enquiries/complaints
- Liaise with healthcare providers, TPAs
- Present to brokers/corporate clients on claim processes
- Tracking of operational statistics for Claims reporting
- Handling of exceptional claims escalated issues and appeals
- Perform claims audit/review as and when assigned
- Carry out task assigned by Team Lead and Head of Claims
- Managing and responding for escalation cases/requests from OSS Contact Centre, Claims, and PMM team, Brokers and Direct clients and internal sections
- Perform claims data analysis to monitor results and identify any gaps or trends as part of the Pro-Active Claims Management
- Plan and execute User Acceptance Test (UAT) Test scenarios for digital projects and system enhancement
- Support any other enhancements, internal and external projects as assigned
Requirements
- Degree Holder in Business or a related discipline preferred
- Prior experience of no less than 3 years in Employee Benefits Claims or Medical Claims or Third-Party Administration management
- Strong analytical and problem-solving skills, in developing solutions via digitalization, interest in operational systems and its efficiency
- Good verbal & written communication skills and good interpersonal skills
- Able to multi-task, meet tight deadlines and work in fast paced environment
- The individual will need to be self-motivated, highly organized, able to work independently and goal oriented
- Experience in data analysis is added advantage
