Working Location: Adjacent to Farrer Park MRT

Working Week: 5.5 days

Working Hours: 9 am to 6 pm (Monday to Friday)

Saturday: 9 am to 1 pm

We are looking for an experiened Claims & Operations Manager who can achieve 98% claims success, ensure timely submissions, smooth operations, strong partner and client relations, guide juniors, gain insurer knowledge, act independently, communicate transparently, uphold values, and support teamwork.

Key Role & Responsibilities:

1. Claims Management

1. Manage and audit all claims forms and medical reports
2. Liaise with clinics and hospitals regarding claims and medical reports
3. Ensure PH's questionnaire and claim forms are completed and submitted to Insurer in timely manner
4. Ensure pre- & post hospitalization claims are filed to Insurer in timely manner
5. Monitor claim progress for each admission and/or case closely
6. Maintain and update PH's claim summary
7. Retrieve claims update from hospitals and centers, PHs or their ICs and update into Pcare Connect
8. Provide claims status update to stakeholders via respective channel
9. Final bill update and claim closure
10. Pre-assess each case submission and audit Estimated Claim Spreadsheet (ECC)
11. To study different health insurance products and monitor trends of claim assessment and approval for different products
12. To participate in improving claims submission and management processes
13. Provide claims advice to Business Development Team
14. Conduct monthly claims review meeting before 10th of every month
15. Generate ad-hoc report as and when required

2. Operations

1. To ensure operation process is smooth and seamless by overseeing and audit processes below:
2. i. Movement Update and appointment reminders to PHs
3. ii. Admission, Discharge & Out-patient Consultation
4. iii. Post hospitalisation calls to PHs
5. iv. Post service feedback calls to PHs
6. To supervise the operation process for quality control
7. To participate in improving company sales operation process

3.Data & Systems Management

1. To update and ensure accuracy of the information including but not limited to details of PH, admission, discharge, procedure, surgical code/table, insurance policy for each entry
2. To ensure PH's information, medical reports and bills, claim submissions are properly filed into system according to the Company's protocol
3. To assist and participate in system improvement

4. Others

1. Organize, schedule and/or assist company's meetings including companyevents
2. Take accurate meeting minutes and submit to HOD within 3 working days after meeting, and to ensure proper documentation filing
3. Other ad-hoc duties assigned by seniors and management especially during and/or after office hours

Skills Set

1. Strong relationship management skills
2. Strong interpersonal and communication skills, both written & verbal
3. Ability to understand and resolve issues effectively
4. Adaptable, resilient, ability to multi-task and to work well in a dynamic and fast-paced environment
5. Confident and passionate in customer service quality
6. Resourceful, pro-active and analytical with an eye for detail
7. A good team player, meticulous, organized and ability to adapt to the company's culture
8. Ensure patients confidentiality at all times
9. Flexibility in supporting all ad-hoc duties
10. Ensure responses to queries are prompt and detailed