Manager, Medical Claims

4 days ago

Singapore Doctor Anywhere Full time

**About the team**

Doctor Anywhere's Operations team is a crucial part of the company. We ensure the day-to-day excellence of our TPA business, virtual and in-person clinical services, resolving operational issues in a timely manner and providing the best customer experience possible. We make sure that our customers remain our top priority.

**The role we are hiring for**

We are seeking a **Manager, Medical Claims **who is responsible for leading the claims team in ensuring accurate and timely administration of claims.

This role reports directly to the Senior Manager, Claims.

A summary of the key responsibilities and requirements are as follows:
**Responsibilities**
- Demonstrate thorough understanding of health technical claims assessment and processes
- Ensure accurate and timely assessment of health claims within the required service standards
- Assist Head of Claims to monitor and manage timely closure of outstanding claims
- Handle claim enquiries, service recovery, complaints, appeals and other customer care matters
- Perform claim peer review inspection for claims exceeding assessor’s authority limit
- Review and prepare claims SLA reporting as per stipulated timeline
- Conduct health technical claims assessment and training for new joiners
- Manage work relation with external parties such as medical institutions, clients, etc
- Manage key internal stakeholders such as claims, network management teams etc. to ensure all service level agreements are met
- Participate in operation efficiency and A.I. driven projects to bring efficiency to claims processes
- Review onboarding process for new accounts i.e acts as Subject Matter Expert (SME) for claims and identify any gaps relevant to claims
- Manage other ad-hoc projects as assigned from time-to-time

**Requirements**:

- Degree or Diploma in any discipline with at least 8 years of relevant Health claims assessment experience
- Strong background in Medical claim, specifically technical claims assessment and claims management
- Strong policy language skills enabling accurate and consistent policy wording interpretation
- Strong knowledge of health eco-system or operations of medical institutions will be an added advantage
- Strong analytical, written and communication skills
- Strong critical thinking skills and ability to handle complex computations
- Meticulous with a keen eye for details
- Customer centric
- Ability to work under pressure and manage deadlines
- Team player and self-motivated

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