Manager - Medical Claim

Job Purpose

You will be handling insurance claims assessment under our health plans. You will also be given the opportunity to be part of an exciting team with involvement in service excellence initiatives and projects to improve the claims experience.

The Job

• Provide accurate and timely assessment of medical claims within the required service standards and ensure that claims are paid accurately and promptly.
• Handle claim investigations and claim appeals in accordance with established procedures.
• Deliver excellent service and enhance customer and distribution channels relationship management.
• Review claims processes and participate in process improvement projects, initiatives and system enhancement for the department, including establishing claims best practices.
• Take accountability in considering business and regulatory compliance risks and take appropriate steps to mitigate the risks.
• Maintain awareness of industry trends on regulatory compliance, emerging threats and appropriate steps to mitigate the risks.
• Highlight any potential concerns/risks and proactively share best risk management practices.
• Any other ad-hoc projects assigned by the supervisor.

Our Requirements

• Degree or Professional Insurance Certificate with at least 5 years of relevant shield claims experience.
• Mid-level claims assessors who are looking for greater exposures.
• Strong knowledge of integrated shield claim processes and industry initiatives in managing medical claim costs.
• Customer-centric and meticulous with the ability to work under pressure.
• Strong analytical, written and communication skills.
• Excellent interpersonal skills to effectively communicate with all stakeholders.
• Good medical knowledge and ability to explain medical conditions in an insurance context.
• Good business acumen with a long-term vision.
• A team player.
• High level of integrity, takes accountability of work and good attitude over teamwork.
• Takes initiative to improve the current state of things and is adaptable to embrace new changes.