Senior Claims Operations Specialist

1 week ago

Singapore beBeeClaim Full time $100,000 - $130,000
Job Description

The Life and Health Operations department plays a pivotal role in ensuring customers have affordable and comprehensive life and health products with efficient processes to provide optimal service.

As an Assistant Manager of the Claim Operation Specialist unit, you will manage projects and provide central claims support including product reviews system support governance peer reviews and continuous improvement to claim operations.

You will work closely with the claim processing team to ensure operational targets are met and will have the opportunity to cross-train on other claim types.

  • Product Review
  • Perform review of contract and product specification including requirements for system changes coordinating teams inputs workgroup discussions on medical and life claims.
  • Be part of the product implementation workgroup and work with internal and external parties.
  • System Support
  • Serves as a Claim Subject Matter Expert liaison and reference point between Claim Business and the Business Analyst (BA)/Technical analyst ensuring business requirements are translated to functional requirements.
  • Conduct prioritization with BA and IT on system enhancements.
  • Support production issues rectifications data patches/configuration changes or tasks that require testing etc.
  • Involved in ongoing requirement gatherings.
  • Review impact/process changes due to system changes.
  • UREQ/BSD review from claim business user perspective.
  • Engagement communication & briefing to stakeholders on impact areas in relation to system/product/benefit changes.
  • Governance
  • Management of work instructions and documentation control.
  • 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 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 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 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.

 

Required Skills and Qualifications

  • Diploma/Degree holder with five or more years of experience in Shield Claims.
  • Strong background in 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.

 

Key Responsibilities
  • Manage project and provide central claims support
  • Support product reviews, system support, governance and peer reviews
  • Work closely with claim processing team to ensure operational targets are met
  • Lead and participate in operation efficiency projects
  • Support the Claims team in compliance reporting
  • Communicate effectively with reinsurers, auditors and external stakeholders

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