Manager, Claims
Kwun Tong, Kowloon, Hong Kong

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 :

Claims Management

  • 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.

    Vendor Management

  • 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.

    Stakeholder Management

  • 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.

    Data Analytics

  • 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.


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