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Claims & Operations Manager
3 weeks ago
Work Location: Central Region
Work Days: 5.5
Working Hours: Monday to Friday: 9 am to 6 pm
Saturday: 9 am to 1 pm
**Job Responsibilities
**I. Claims Management**:
- Manage and audit all claims forms and medical reports.
- Liaise with clinics and hospitals regarding claims and medical reports.
- Ensure Policy Holder's (PH) questionnaire and claim forms are completed and submitted to the Insurer on time.
- Ensure pre
- & post-hospitalization claims are filed with the Insurer promptly.
- Monitor claim progress for each admission and/or case closely.
- Maintain and update PH's claim summary.
- Retrieve claims updates from hospitals and centers, PHs, or their Insurance Companies and upload them to the Company Connect Portal.
- Provide claims status updates to stakeholders through the respective channel.
- Update the final bill and claim closure.
- Pre-assess each case submission and audit the Estimated Claim Spreadsheet (ECC).
- Study various health insurance products and monitor claim assessment and approval trends for different products.
- Participate in improving claims submission and management processes.
- Provide claims advice to the Business Development Team.
- Conduct monthly claims review meetings monthly and generate ad-hoc reports when required.
Train and manage junior claims associates to meet claims department KPIs consistently.
**II. Operations**:
- Ensure the operation process is smooth and seamless by overseeing and auditing the processes below:
Supervise the operation process for quality control and participate in improving the company sales operation process.
**III. Data & Systems Management**:
- Update and ensure the accuracy of the information, including, but not limited to, details of PH, admission, discharge, procedure, surgical code/table, and insurance policy for each entry.
- Ensure PH's information, medical reports, bills, and claim submissions are filed adequately into the system according to the Company's protocol.
Assist and participate in system improvement.
**IV. Others**:
- Organize, schedule, and/or assist with company meetings and events.
- Take accurate meeting minutes and ensure proper documentation filing.
Perform other ad-hoc duties assigned by seniors and management, especially during and/or after office hours.
**Job Requirements**
- At least 3 years of experience handling health and personal accident claims.
- Strong relationship management skills and interpersonal and communication skills, both written and verbal.
- Ability to understand and resolve issues effectively.
- Adaptable, resilient, able to multitask, and work well in a dynamic and fast-paced environment.
- Confident and passionate about customer service quality.
- Resourceful, proactive, and analytical with an eye for detail.
- A good team player, meticulous, organized, highly adaptable, and flexible in supporting all ad-hoc duties.
- Protect information security and provide responses to queries prompt and detail.
