TPA Claims Manager
Ethos BC Global
China & Hong Kong
source : JXT

A global health insurance provider is looking for a customer-centric individual to join their team as TPA Claims Manager.

This is a critical role overseeing and managing the service partner activities for the Hong Kong business, and guiding a small team of claims handlers.

You will monitor the claims processes to ensure best practice and customer experience, review both outsourced and high value claims for approval.

To succeed in this role, you will need to demonstrate previous medical claims experience, strong knowledge of hospital networks and provider management as well as execute strong relationship management skills in dealing with stakeholders.

Main Responsibilities :

  • Oversee and support the service level agreement delivery of service by the TPA in Hong Kong including but not limited to
  • Review the claims processes for best practice and customer experience
  • Review and approve health claims up to agreed amounts
  • Work with the customer to deliver great service
  • Build relationships with the key stakeholders
  • System / process enhancement co-ordination between the entity and the TPA
  • Design and assist in the delivery of medically related training which supports the product sales
  • Complaint handling
  • Skills / Experience :

  • Previous experience in handling medical claims, ideally 5 years and beyond
  • Clinical knowledge and / or training would be prioritised
  • Strong understanding of Hong Kong market and industry
  • Knowledge of hospital networks and provider management
  • Strong relationship management skills
  • Interested candidates can forward their CVs in MS Word format to Sherry quoting reference number SL / AFRW-705303 / JEN

    Licence no. 16S8112

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