Insurance Claims Specialist
20 hours ago
About the Role:
We are seeking an experienced Insurance Claims Specialist to join our team at PERSOLKELLY SINGAPORE PTE. LTD.
Job Summary:
The incumbent will be responsible for providing medical advice in terms of claims insurance adjudication, supported by the reinsurers' Chief Medical Officer where appropriate, and to make decisions and recommendations on complex medical claims/high value claims (including Controlled Claims referred by Partners), within the delegated authority given.
Responsibilities:
- Medical Advice, Controlled Claims and Claims Decisions:
• Ensuring that all Controlled Claims are duly authorised in accordance with Reinsurer contractual arrangements and that the required reporting is in place
• Preparation of Controlled Claims reporting
• Handle claims cost management within the organisation by ensuring high standard of claims assessment - Claims Audits:
• Manage Claims Audits in accordance with the Annual Audit Schedule
• Deliver Audit Reports to Clients and the business in accordance with company's standards
• Audits performed in accordance with the Claims Audit Policy
• Liaison and follow-up on Claims audit findings and implementation with auditees - Contribution to Partnership Activity:
• Policy Wording design and interpretation
• Training claims processes
• Processes for the management of claims and controlled claims
• Input in Policy Wording Forum - Fraud, Waste and Abuse:
• Identify and evaluate potentially fraudulent claims and claims wastages and abuses and taking appropriate action to rectify the anomalies - Training and Presentation:
• Best practices on claims processing and guidelines
• Claims case studies sharing
• Claims-related medical topics sharing
Requirements:
- Strong knowledge of healthcare and insurance markets
- Experience with health insurance claims handling
- Possess the drive and determination to set, meet and improve upon the highest standards of performance.
- Able to work co-operatively and collaboratively with others to achieve business goals
- Understand the customers' needs to deliver quality work in an efficient manner.
What We Offer:
• Competitive salary: SGD $90,000 - SGD $120,000 per annum
• Opportunity to work in a dynamic and growing industry
• Collaborative and supportive work environment
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