The incumbent will lead the daily operations of both individual and group medical claims teams. He / She will also manage the performance of external service providers to deliver the best quality claims service to our policyholders, members, brokers and business partners.
Job Responsibilities :
Lead the overall claims team and resources to perform various claim administrations processes effectively and efficiently while striking a balance between compliant to claims guideline and customer centricity;
Adjudicate referred medical or life claims under different distribution channels. Monitor the claims procedure in compliant to internal guidelines and update related documents accordingly;
Review referred complaints. Oversee the mitigation of weakness to improve the extent of customer centricity;
Act as a coach to the team to develop the team’s knowledge and skillset, and groom individual’s career.
Control the performance of external vendors closely to meet the agreed service levels and KPI;
Oversee the Network / Third Party Administrators (TPA) to deliver the required claims service to both our internal and external customers;
Review the service agreement regularly to update the scope of services, terms and pricing;
Liaise with external vendors to support new or enhanced services;
Conduct audit review of claims processing by external vendors to identify improvement areas and ensure adherence to standards and guidelines set by the company and regulations.
Build and maintain strong relationship with external vendors, clients and internal front-end and back-end teams by providing training or presentation on the company’s claims services;
Work closely with internal IT and external IT vendors to manage the end-to-end process of system enhancement including full cycle user requirement gathering and UAT.
Monitor compiled management report and ad-hoc report for claims management;
Analyze claims data to identify problem’s root causes, propose resolutions and execute improvement plans.
Job Requirements :
Degree holder, preferably with insurance-related qualifications, e.g. LOMA, FLMI, ICA;
At least 8 years’ experience in medical claims adjudication / administration of which at least 3 years in supervisory role;
Solid technical skills in individual and group medical claims;
Experience in working or managing the Network / Third Party Administrators (TPA);
Proven track record of working with IT, vendors and stakeholders on product development, developing user requirements and test cases for system, and conducting UAT;
Proficiency in Microsoft Excel with analytical mindset;
Frequent user of Microsoft PowerPoint. Confident to present ideas visually and verbally;
Good team player, able to work independently and under pressure in a fast-paced environment;
Possess strong customer centricity mindset;
Excellent interpersonal, communication and influencing skills;
Cantonese speaker with good command of both English and Chinese.