[sg] Manager, Case

1 week ago

Singapore Doctor Anywhere Full time

**About the role**

This role reports directly to the Head of Claims.

A summary of the key responsibilities are as follows:

- Responsible to oversee the daily operation of pre-authorization team to achieve the expected Key Performance Indicator (KPI) and meet monthly service objectives (SLA).
- Working together with the team and Head of Claims in supporting business and process operational efficiency. Provide dedicated of Letter of Guarantee/Pre-Authorization services to stakeholders in ensuring delivery of key service objectives through efficient and effective claims management.
- Overseas and take necessary steps to manage suspicious claims and investigation whenever necessary.
- Ensure the team has adequate on-the-job training and guidance especially the junior case assessors to administer of Letter of Guarantee/Pre-Authorization and align with the terms and conditions of the policy.
- Manage communications, queries, feedback and complaints. This would include appeals.
- Communicate and follow-up with policyholders in relation to the of Letter of Guarantee/Pre-Authorization or enquiries whenever necessary.
- Manage and provide accurate and timely assessment of pre-approval of medical claims whenever necessary.
- Ensure any suggested treatment plans fall within policy terms and conditions.
- Work closely with Specialists, Clinics and Hospital groups in relation to the Letter of Guarantee or Pre-Authorization requests.
- Maintain accurate case records and all related communication.
- Ensure compliance with internal and external regulatory guidelines eg MOH benchmarks
- Be exposed to data analytics tools as part of your assessment work.
- Consolidate, review reporting deck accuracy, and facilitate regular / monthly meetings with clients for operations review of SLAs/TATs, and ensure all SLAs/TATs are met.
- Support and work closely with Head of Claims and stakeholders for process improvement and system enhancement to achieve operational efficiency and effectiveness. This involves working closely with the respective stakeholders involved to achieve the best outcome of business efficiency.
- Any other special projects and ad-hoc duties assigned when appropriate.

**About you**
- Diploma/Degree, preferably within studies of Bio-sciences, Nursing or Statistics with at least 5 years if relevant working experience in claims processing, and at least 3 years of experience managing a team.
- Experience in Insurance/Third-Party Administrators/ Healthcare industries is a must.
- Able to work under intense pressure and tight timeline.
- Self-motivated and able to work independently.
- Excellent communication, interpersonal and problem-solving skills.
- Ability to guide and support the team throughout business changes and maintain positive morale within the team.
- Ability to build and maintain trusted relationship with internal and external stakeholders.
- Strong command of English, oral and written.
- Ability to handle and mediate sensitive issues calmly, empathetically and professionally.
- A start-up attitude - you take full ownership of things that you do, willing to go out of your comfort zones and take on new challenges.
- Comfortable with ambiguity - we are a fast-growing business and there's always unchartered territories, which is part of the fun. You should be comfortable with it and understand that not everything is 100% defined all the time.

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