
Claims & Operations Manager
5 days ago
Working Location: Adjacent to Farrer Park MRT
Working Week: 5.5 days
Working Hours: 9 am to 6 pm (Monday to Friday)
Saturday: 9 am to 1 pm
Role and Responsibilities:
1. Claims Management- Manage and audit all claims forms and medical reports.
- Liaise with clinics and hospitals regarding claims and medical reports.
- Ensure PH's questionnaire and claim forms are completed and submitted to the insurer in a timely manner.
- Ensure pre- and 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 claim updates from hospitals, centers, PHs, or their ICs, and update into Pcare Connect.
- Provide claims status updates to stakeholders via respective channels.
- Finalize bill updates and claim closures.
- Pre-assess each case submission and audit the Estimated Claim Spreadsheet (ECC).
- Study different health insurance products and monitor trends in claim assessment and approval for various products.
- Participate in improving claims submission and management processes.
- Offer claims advice to the Business Development Team.
- Conduct a monthly claims review meeting before the 10th of every month.
- Generate ad-hoc reports as needed.
To ensure the operation process is smooth and seamless by overseeing and auditing the processes below:
i. Movement Update and appointment reminders to PHs
- ii. Admission, Discharge & Outpatient Consultation
- iii. Post-hospitalisation calls to PHs
- iv. Post-service feedback calls to PHs
- To supervise the operation process for quality control
- To participate in improving the company's sales operation process
3. Data & Sy stems Management
- To update and ensure accuracy of the information, including but not limited to details of PH, admission, discharge, procedure, surgical code/table, and insurance policy for each entry
- To ensure PH's information, medical reports and bills, claim submissions are properly filed into system according to the Company's protocol
- To assist and participate in system improvement
- Organize, schedule and/or assist the company's meetings, including company events
- Take accurate meeting minutes and submit to HOD within 3 working days after the meeting, and ensure proper documentation filing
- Other ad-hoc duties assigned by seniors and management especially during and/or after office hours
- Strong relationship management skills
- Strong interpersonal and communication skills, both written & verbal
- Ability to understand and resolve issues effectively
- Adaptable, resilient, ability to multitask and to work well in a dynamic and fast-paced environment
- Confident and passionate in customer service quality
- Resourceful, pro-active and analytical with an eye for detail
- A good team player, meticulous, organized, and able to adapt to the company's culture
- Ensure patients' confidentiality at all times
- Flexibility in supporting all ad-hoc duties
- Ensure responses to queries are prompt and detailed
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