Head of A&H Claims
Posted on Friday, August 18, 2023
- Coordinate with relevant stakeholders to provide best customer service
- Approve claims within authority & establish fair practices in claims settlement in terms of claim genuineness, liability & breakdown assessment
- Keep stakeholders informed on the progress of the claim
- Update necessary claim information into database & ensure staff’s accuracy in data-entry
- Ensure claims operation is in compliance to regulatory guideline
- Provide necessary support in accordance to Company’s directive
- Manage fraud, safeguard Company’s interest by acting on leakages and ensure accurate liability assessment
- Provide report on TAT, outstanding & irregularity listing to HOD on weekly basis with action plan
- Handle and manage authority regulatory matters and complaints within timeline
- Ensure departmental KPIs meet management requirement
- Conduct check & balance & monitoring within internal & external processes
- Perform quarterly evaluation on panel vendors
- Conduct necessary training & transfer of job knowledge on regular basis
- Analyze claims & report to HOD on any irregular trends & malpractices & correct recoveries from all parties
- Ensure claim cases with large amount has been informed to re-insurer and comply with company retention (if any)
- Ensure Cash Calls & XOL’s are monitored & made in timely manner (if any)
- Administer best practices & smooth day-to-day operation
- Prepare necessary reports as required by HOD
- Handle any other portfolio as required by management
- Bachelor degree or higher, preferably in nursing science.
- Knowledgeable in health and accidental claims.
- At least 5 years of insurance experience.
- Be reliable and skilled in communicating.
- Good analytical skills.
- Strong leadership.
- Self-starter with readiness to groom the team towards service excellence.
- Computer literate with focus on process & system improvement.
- Good command of spoken and written English.