Senior Claims Manager - Medical

Key Responsibilities:

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  Team Leadership and Strategy:
  • Guide the team in formulating and executing technical and service strategies for Group Medical and Individual Healthcare claims.
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  Quality Assurance:
  • Ensure the team consistently delivers exceptional technical and professional service to both internal and external stakeholders.
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  Process Optimization:
  • Leverage digital tools and innovative strategies to enhance the claims process and workflows, aiming to elevate customer experience and service delivery.
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  Claims Administration:
  • Oversee the timely and accurate processing of claims, making well-informed decisions on complex or large claims, and serve as a key point of reference for the team.
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  Fraud Management:
  • Establish and implement effective measures to detect and mitigate fraud, waste, and abuse, reducing financial losses from fraudulent claims.
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  Marketing Support:
  • Engage in marketing initiatives to contribute to new business opportunities from a claims perspective.
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  Reporting:
  • Generate and submit monthly statistical and analytical claims reports promptly, including large loss advisories in line with company standards.
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  Performance Evaluation:
  • Monitor and assess the performance of service providers to ensure optimal service quality.
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  Team Development:
  • Cultivate a skilled service team by providing comprehensive coaching and training to enhance the capabilities of team members.