Manager, Claims (Hospital & Surgical)

Responsibilities

  • Handling, Processing, Recommend Settlement of claims in accordance with policy contract, company policy and procedures.
  • Compliance of all the claims processes, procedures and guidelines as stipulated in the Claims Operation Manual and/or instructions.
  • Provide quality, prompt and efficient claims service to meet Customer satisfaction.
  • Review/follow up on all outstanding claims on regular basis to ensure claims reserve are adequate and status updated. Maintain a low pending ratio of outstanding claims (prompt disposal of claims to reduce number of outstanding claims).
  • Assist superior to handle major large losses / event losses / complicated / litigated claims i.e. preparation of Major Loss Advice (MLR), preliminary loss / development and settlement loss / cash calls advice to co/reinsurers on timely manner. Keep Reinsurance and Finance advised of any material claims as set in the claim manual / procedures and work with Reinsurance to effect recoveries.
  • Keep ratio of outstanding claims at healthy level.
  • Highlight to supervisors and/or HODs of any deficiency in policy coverage and adverse claims trends to facilitate corrective and appropriate action.

Requirements

  • Minimum Degreeor Professional Qualification in Insurance.
  • Preferably with minimum 7 years experience in Accident and Health claims.
  • Effective written and communication skills.
  • Sound knowledge and experience in all aspects of Claims.
  • Strong product knowledge.
  • Team player with good track record
  • Strong analytical skills and business acumen.