Claims Manager

The claim manager is responsible for managing the insurance claims team on a daily basis to ensure the optimal handling of all claims and achieving monthly targets that are aligned with the strategic objectives of the company. The claims manager will also oversee electronic and manual claim processes, claim adjudication, claim settlement, claim adjustments and quality assurance processes, set up follow-up actions and evaluate the areas for further training and development of the claims team or claim systems. Other responsibilities will include handling, investigating and providing guidance in complex claim cases and claim dispute cases in collaboration with internal and external stakeholders, in addition to preparing reports, analysing claims data and identifying trends for stakeholder review, analysis and audits.

Responsibilities

1. Manage the claims team, which includes claim assessors and mailroom personnel.
2. Oversee and improve the operational claims workflow process.
3. Manage the day-to-day work assignments and distribution of tasks to the claims team.
4. Provide guidance and serve as an escalation point of contact for the claims team.
5. Work closely with the medical or clinical team to assess and settle complex, grey areas and dispute cases.
6. Manage and increase the effectiveness and efficiency of claims processing through improvements to each function, as well as coordination and communication between teams.
7. Review, assess and settle cases requiring claim adjustments and oversee the claim quality assurance process.
8. Recognise and challenge possible fraudulent information and proactively seek to clarify and resolve using the best method of communication and initiative.

Required Skills

1. A bachelor’s degree in business administration or a related discipline is necessary; a Master’s degree is preferred.
2. At least 5 years of experience as an insurance claims adjustor, claims examiner, or claims supervisor, preferably in a leadership role.
3. Must thoroughly understand insurance-related legal procedures, regulations and claims processing.
4. Excellent analytical and problem-solving skills.
5. Ability to organise, document and control both digital and physical data.
6. Literate in IT, specifically in CRM/ERP software.

Job Benefits and Compensation

1. DocDoc offers a very competitive salary depending on experience.
2. 15 days paid vacation each year, earned at a rate of 1.25 days per month.
3. Sick days as needed, not to exceed 10 per year.
4. Health Insurance monthly stipend.
5. Flexible time and availability to work from home from time to time.