Claim Ops Specialist

4 days ago


Singapore INNOVATIVE CONSULTING PTE. LTD. Full time
Roles & Responsibilities

Responsibilities:


• Product Review (Medical and Life Plans)

o Perform Review of Contract and Product Specification, including providing requirements for system changes, coordinating/solicit teams inputs, workgroup discussions on medical and life claims.

o Be part of the product implementation workgroup and have opportunity work with various internal and/or external parties.


• System Support

o Serves as a Claim Subject Matter Expert, as a liaison and reference point between Claim Business and the Business Analyst (BA)/Technical analyst, ensuring that the business requirement are translated to functional requirements

o Conduct prioritization with BA and IT on system enhancements

o Support all production issues, rectifications, data patches/configuration changes or tasks that requires some testing etc. o Involved in ongoing requirement gatherings

o Review impact/process changes due to system changes

o UREQ/BSD review from claim business user perspective


• Engagement, communication & briefing to stakeholders on impact areas in relation to system/product/benefit changes


• Governance

o Management of work instructions and documentation control

o Ensure governance and due diligence over claim processes and services engaged by Claims Section


• Perform claim peer review inspection


• Review and suggest process improvements for developing or implementing best practices. Lead and participate in operation efficiency projects to bring efficiency to claims processes


• Support the Claims team in any compliance reporting, monitoring/reporting of exceptions, claim financial tracking, planning, and strategizing of claims management and other related duties


• Work closely and maintain good rapport with representatives (financial consultants, advisers, brokers, etc.), officers and staff of other departments to carry out his/her work effectively


• Communicate effectively with reinsurers, auditors and external stakeholders such as the CPF Board, and hospitals, clinics, nursing homes in the course of claims administration or audits


• Conduct Claims Workshops to financial advisors when the need arises


• Undertake any projects or duties, including administrative duties, as assigned by Section Manager or Head of Function

Qualifications:


• Diploma/Degree holder with five or more years of experience in Claims


• Strong background in Life & Integrated Shield claim processes


• Strong policy language skills enabling accurate and consistent policy wording interpretation


• Strong critical thinking skills and ability to handle complex computations


• Strong written and communication skills, committed team player


• Ability to work under pressure and manage deadlines


• Meticulous with good analytical, organisational skills


• Able to multi-task and work independently


• Customer centric

Tell employers what skills you have

Claims Management
Able To Multitask
Microsoft Office
Hospitals
Due Diligence
Reinsurance
Critical Thinking
Administration
Underwriting
Audits
Nursing
Team Player
Business Analyst

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