Health Insurance Claims

2 weeks ago

Central Region, Singapore PERSOL Full time $90,000 - $120,000 per year

The incumbent will be responsible for providing medical advice in terms of claims insurance adjudication, supported by the reinsurers' Chief Medical Officer where appropriate and to make decisions and recommendations on complex medical claims/high value claims (including Controlled Claims referred by Partners), within the delegated authority given to company by each reinsurer. The role will also support product development and design for existing and new Insurance Clients in particular with regards to Policy Wording and Claims Practices including the delivery of operational processes and claims related training.

Responsibilities

1.  Medical Advice, Controlled Claims and Claims decisions

•  Ensuring that all Controlled Claims are duly authorised in accordance with Reinsurer contractual arrangements and that the required reporting is in place

•  Preparation of Controlled Claims reporting for each Reinsurer and to EXCOM

•  Handle claims cost management within the organisation by ensuring high standard of claims assessment

2.  Claims Audits

•  Manage Claims Audits in accordance with the Annual Audit Schedule

•  Deliver Audit Reports to Clients and the business in accordance with company's standards 

•  Audits performed in accordance with the company's Claims Audit Policy

•  Liaison and follow-up on Claims audit findings and implementation with auditees

3.  Contribute and support all Partnership activity relating to claims activity such as:

•  Policy Wording design and interpretation 

•  Provide Claims Training for Partners or TPA 

•  Processes for the management of claims and controlled claims

•  Input in Policy Wording Forum

4.  Fraud, Waste and Abuse 

•  Identify and evaluate potentially fraudulent claims and claims wastages and abuses and taking appropriate action to rectify the anomalies

•  Tracked FWA for reporting purpose

5.  Provide or assist in prevention and training to internal and external stakeholders 

•  Best practices on claims processing and guidelines

•  Claims case studies sharing

•  Claims-related medical topics sharing

6.  Monthly reporting

•  Prepare monthly reports as required by management

7.  Require to be on standby to handle urgent claims approval after office-hour / weekend for one-week duration on monthly basis

Requirements

•  Medical background with experience in nursing or allied health professionals are welcomed to apply

•  Strong knowledge of healthcare and insurance markets

•  Experience with health insurance claims handling

•  Good written and communication skills for effective claims handling toward all stakeholders

•  Reliable and trustworthy to handle assigned task in a responsible manner

Interested candidates who wish to apply for the advertised position, please click on "Apply". We regret that only shortlisted candidates will be notified.

EA License No.: 01C4394 (PERSOLKELLY Singapore PTE LTD)

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