About the Role
The successful candidate will be responsible for all operational and servicing delivery for Insurance Partners, in the context of the Partnership & Reinsurance (P&R) business, including management of Service Partners (TPAs), provision of a global medical claims service, review and approval of claims and control and auditing function. This is a global role with team members based across the world (majority in Singapore, France and UK). The role will also support product development and design for existing and new Insurance. Implementing new claims practices and leveraging innovation and technology to improve P&R service offering to Clients and claims related value-adds as well as portfolio profitability is a priority.
The successful candidate will be responsible for all operational and servicing delivery for Insurance Partners, in the context of the Partnership & Reinsurance (P&R) business.
Responsibilities
- Operational Partner Service Delivery
- Provide full claims and operational support to Partners
- Manage TPAs on behalf of Partners, with regular reporting on performance against agreed Service Level Agreements (SLAs)
- Support in operational set-up with new Partners, designing processes for the management of claims, offering training, assisting in the appointment and contracting of TPA's, providing required regulatory governance requirements for Partners such as due diligence, data protection, security checks and annual compliance reports
- Claim management including Fraud, Waste and Abuse (FWA)
- Ensure management of all Partner Controlled Claims is in place globally with clear processes set out and agreed with the Partners utilizing team knowledge and the expertise of the HMA
- Provide medical support and claims adjudication of Controlled Claims in order to manage (Re)insurer risk
- Ensure that all Controlled Claims are duly authorized in accordance with (re)insurer contractual arrangements and that the required reporting is in place
- Claims decisions supported by the Partners and the Reinsurers
- Provide expected Controlled Claims reporting to (Re)insurers and Claim Management committee
- In collaboration with the Claim Technical Excellence team, oversee the approach to Fraud, Waste and Abuse ensuring that the right check-points exist in all the Partnership servicing arrangements
- Set annual FWA targets and track progress against it
- Control and Audit of TPAs
- Manage the TPAs performance ensuring that all contractual SLA's and services that the Insurance Partner has agreed are delivered, with regular reporting against SLA's and operational business performance
- Perform TPAs Audits (audit of the TPA ensuring compliance with Outsourcing Policy, IS Policy and all other Group Standards and external compliance requirements, as well as specific claim audits) in accordance with the Annual Audit Schedule adopting a risk based approach
- Regularly review and control Audit Policy in collaboration with the Claim Technical Excellence team
- Perform Audits in accordance with Audit Policy
- Deliver Audit Reports in accordance with AXA standards
- Audit findings discussed at the Claim Management Committee and with the Partners, action plans put in place and tracked to completion
- Global Network
- Liaise with and support the Global Network team within Claim Technical Excellence
- Management of the Protection business which is outsourced to a third-party
Qualifications
- Medically trained, or with a strong medical background
- Knowledge of healthcare and insurance markets
- Good Years of experience in working in an international environment with team members in various countries
- Experience with health and protection insurance claims handling and associated risks
- Familiar with audit or control functions
Required Skills
- Negotiation and stakeholder management skills
- Continuous improvement – the drive and determination to set, meet and improve upon the highest standards of performance
- Delivery focus – identifying what needs doing and taking action to get it done, turning complex problematics into simple solutions
- Team leader – acting to build the capability of the team to deliver the maximum performance and fulfil potential
- Team player – working cooperatively and collaboratively with others to achieve business goals
- Customer focus – investing time and energy in understanding the customers needs
- Financial acumen
- Experience with health and protection insurance claims handling and associated risks
- Familiar with audit or control functions
