Individual Claim Assessment Manager
JOB DUTIES:
- Lead assessment team to gain high work efficiency of the objectives as claim productivity, quality, and TAT service;
- Lead assessment team to do Direct Billing Service smoothly;
- Contribute initiates to develop/ enhance claim system;
- Participate to review and standardize claim procedure, esp. assessment procedure to align with Group claim procedure and increase the efficiency;
- Join the meeting to report to Group/ GARO quarterly;
- Join Claims Committee Meeting quarterly;
- Responsible to follow Claim Report, analyze claim trends to escalate promptly to Claims Management if having abnormal trend as fraud/ abuse trend, … and give the solution and implement the ways to treat them;
- Manage complaints/ enquiries of customers or agents related to claim decisions. Review appeal claims, give decision or propose the solution to Claim Head. Co-operate with Administration Team / Complaint Handling Team in response to customers/ agents;
- Cross function: co-operative closely with other departments: with Compliance in controlling the risks, educate Sales Force, contribute claims experience in building new products, co-operate with actuary to control A/E, claim loss…
- Responsible for training and development claim assessors, build a professional assessment team, apply SOHI culture in work, build an engaged team.
JOB REQUIREMENTS:
1) Education:
- University degree
- Medical, law or economic background is preferred
- Additional Qualifications such as LOMA, English
2) Experience:
- At least 3-year experience in claim assessment field, and
- At least 1-year experience in management role
3) Skills:
- High level of integrity
- Expertise in insurance field, strong analytical, assess and communication skills
- Law and medical knowledge
- Knowledge in computer software and using computer system
- Negotiation skill
- Fluent English communication
- Good initiate and innovation
- High commitment and self-motivation
- Have ability to organize the work and work under high pressure
- Positive attitude. High team-work spirit and human touch