Senior Executive, Claims
Senior Executive, Claims
income insurance limited3-5 Years
- Posted 18 hours ago
- Be among the first 10 applicants
Job Description
Job Description
JOB DESCRIPTION
JOB DESCRIPTION
- Assess and adjudicate Life and Medical claims within authority limits in accordance with policy terms and conditions.
- Conduct claims investigations where necessary, including reviewing medical evidence, policy documentation, and other relevant information to determine claim validity.
- Identify, investigate, and escalate complex claims to the Claims Manager for further review.
- Handle escalation enquiries from policyholders, intermediaries, healthcare providers, and internal stakeholders, providing timely and professional resolutions.
- Handle appeals, complaints, and disputed claims, ensuring fair and consistent outcomes while maintaining a positive customer experience.
- Support continuous improvement initiatives and contribute to enhancing claims processes and customer service standards.
- Perform any other duties as assigned by the Claims Manager.
- Degree in any discipline.
- At least 3 years of experience in Life or Medical Claims handling.
- Certification in Health Insurance and General Insurance (BCP, PGI & ComGI) and Life Insurance qualifications.
- Ability to review and interpret medical reports, hospital bills, policy contract provisions, and investigation findings.
- Excellent communication and interpersonal skills.
- Good customer service, complaint-handling, and stakeholder management skills.
- Strong analytical, investigative, organizational, and time management skills, with attention to detail.
More Info
Key Skills
Medical Claims handling
Life Insurance qualifications
About Company
Skills:
policies & procedures, Microsoft Excel, Logging, Claims Management, Office Skills, Refunds Processing, appeals, legislation, Microsoft Word, completion certificates, Medical Assistance, Claim Handling, Insurance, Hospitalization, Degree in psychology, Microsoft Powerpoint, Reinsurance
Skills:
group insurance products, Email Handling, Medical Claims, contact centre systems