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Monitor claims quality and to ensure our committed service standard are met.
Assist Manager to lead both HK & OSS CS claims team on services deliverables, including effectively handle matters ranging from administrative support, claims adjudication, liaison with different stakeholders and complaint management with service recovery which are in line with the Operations objectives.
3. Put our stakeholders in the center for a satisfactory customer journey.
4. Support new project initiatives provide professional views as a Claims SME, and circulate documentation to achieve a common goal
Roles and Responsibilities :
Claim Payment Review / Processing
Process, review and approve claims processed by OSS according to the Claims Authority Table
Oversees the execution of Claims Practices to ensure claims decision consistency and accuracy, and act according to the terms and conditions set in policy contract
Provide feedback and collaborate closely with OSS to ensure quality and service benchmark are within OSS SOW
Ensure the quality and claims decision from OSS are accurate, consistency and made fairly.
Validate if benefit set up from CCS are correctly done in a timely manner
Claims Servicing
Handle enquires and complaints from customers including agency, brokerage, policyholders and members, to provide professional advice and services on claim related issues
Work closely with CCS, Contact Center, Care & Network Team and other stakeholders to solicit customers’ feedback for better customer satisfaction management, also to improve our end-to-end claims process
Help preparing complaint investigation and coordinate with teams to reassure prompt settlement to customers
Participate as a supportive group member on VIP policies hotline service - to handle member enquiry in claims
Coach & monitor OSS performance on handling VIP policies including emails and claims processing
Ensure service requirements on VIP polices are met
Initiate and execute new ideas to streamline existing workflow to achieve a faster, simpler claims decision.
Quality Assurance and Compliance
Ensure claims function delivered is in compliant with any regulatory requirements and the Company’s policy and practices
Ensure team members handle clients’ personal information with care and comply with any regulatory requirements.
Ensure claim service benchmark are met accordingly including, process turnaround time, output accuracy, with satisfaction from our stakeholders
Other responsibilities
Work with Team Head to monitor team performance
Work with Team Head to allocate and prioritize tasks among team members
Coach and provide technical training to team members and OSS
Performs other responsibilities and duties periodically assigned by Team Head in order to meet operation and / or other requirements
Projects
Engage in all CS related projects to streamline current workflow and provide a seamless experience for the customer journey.
Provide advice & user requirements from benefit design & setting, claims processing & adjudication, payment & client reports for a complete customer journey
Participates as task force members in research; planning & organize; implement & manage; and evaluation on ad hoc projects related to Company & Operation objectives
Work closely with business support team on the design and ensure results are delivered in a timely manner.
Minimum Job Requirements :
University Graduate with minimum 5 years of relevant experience
Claim knowledge in a life insurance company. Expertise in Employee Benefits claims process is in advantage
Self-motivated, analytical and detailed minded in problem solving
Customer-oriented with good teamwork and good communication skills
Good problem-solving skills, and is open to new ideas
Good knowledge on Excel, Word, and PowerPoint
Able to work collectively, with a positive service attitude
Excellent command of written and spoken English and Chinese (Cantonese and Putonghua) 
