Claims & Operations Manager

1 week ago

Central Region, Singapore Authentic HR Pte Ltd Full time $80,000 - $120,000 per year

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
  1. Manage and audit all claims forms and medical reports.
  2. Liaise with clinics and hospitals regarding claims and medical reports.
  3. Ensure PH's questionnaire and claim forms are completed and submitted to the insurer in a timely manner.
  4. Ensure pre- and post-hospitalization claims are filed with the insurer promptly.
  5. Monitor claim progress for each admission and/or case closely.
  6. Maintain and update PH's claim summary.
  7. Retrieve claim updates from hospitals, centers, PHs, or their ICs, and update into Pcare Connect.
  8. Provide claims status updates to stakeholders via respective channels.
  9. Finalize bill updates and claim closures.
  10. Pre-assess each case submission and audit the Estimated Claim Spreadsheet (ECC).
  11. Study different health insurance products and monitor trends in claim assessment and approval for various products.
  12. Participate in improving claims submission and management processes.
  13. Offer claims advice to the Business Development Team.
  14. Conduct a monthly claims review meeting before the 10th of every month.
  15. Generate ad-hoc reports as needed.
2.  Operations

  • 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

  1. 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
  2. To ensure PH's information, medical reports and bills, claim submissions are properly filed into system according to the Company's protocol
  3. To assist and participate in system improvement
4.  Others
  1. Organize, schedule and/or assist the company's meetings, including company events
  2. Take accurate meeting minutes and submit to HOD within 3 working days after the meeting, and ensure proper documentation filing
  3. Other ad-hoc duties assigned by seniors and management especially during and/or after office hours
Skills Set
  1. Strong relationship management skills
  2. Strong interpersonal and communication skills, both written & verbal
  3. Ability to understand and resolve issues effectively
  4. Adaptable, resilient, ability to multitask and to work well in a dynamic and fast-paced environment
  5. Confident and passionate in customer service quality
  6. Resourceful, pro-active and analytical with an eye for detail
  7. A good team player, meticulous, organized, and able to adapt to the company's culture
  8. Ensure patients' confidentiality at all times
  9. Flexibility in supporting all ad-hoc duties
  10. Ensure responses to queries are prompt and detailed

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