Claim Ops Specialist

2 weeks 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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