Claim Officer (Medical Doctor - Healthcare)

PURPOSE:
• In charge of quality control & quality assurance duties.
• Building claims guidelines and procedures for health claims to enhance expertise for prompt and accurate assessment and excellent services.
• Creating effective training programs of medical, underwriting & assessment for claim assessors.
• Ensuring claim assessments are accurate and in strict compliance with the terms and conditions of the contract, while also considering equitable and reasonable factors within the permitted limits to satisfy the customer.
ACCOUNTABILITIES:
• Approving health claims as per prescribed authority limits; resolving complex claims and/or developing recommended solutions based on good judgment, initiative and technical skills.
• Delivering prompt, accurate claim assessments and excellent service to health claims in accordance with Claims Department’s guidelines and procedures.
• Collaborating and maintaining good relationships with cross departments/functions to smoothly solve all claims- related issues and reach claims objectives.
• Supporting department targets and company objectives as and when assigned by the line manager such as building training programs and being in charge of quality assurance & quality control.

REQUIREMENTS
Education and Experience
• Experience in life insurance underwriting is preferable.
• Medical doctor or equivalent, preferably in the insurance field.
Technical skills
• Analytical thinking
• Strong knowledge of claim operations & processes
• Emotional intelligence
• Negotiation for results.
• Identifying and problem- solving
Soft skills
• Proficiency in Microsoft Office (Work, Excel...)
• Collaborative
• Teamwork
• Effective time management
Personal attributes
• Proactive
• Careful
• Integrity
• Enthusiastic
CHALLENGES
• To ensure re- underwriting and claim assessments are accurate, and to be flexible in decisions to satisfy customers within allowable limits
• Work under high pressure.
• Ensure that all claims are handled promptly and effectively with agreed service standards ;

Performance- based salary: Your salary will be commensurate with your skills and contributions.
Comprehensive benefits: Enjoy a generous benefits package including a 13th- month salary; performance- based bonuses; annual salary reviews, 15 days of annual leave, increasing by 1 day every 4 years; and health insurance package for you and your family.
Opportunities for growth: Participate in regular company trips; workshops and knowledge- sharing sessions to enhance your skills and career development.
Clear career progression: We provide a defined career path with opportunities for advancement.

Cập nhật gần nhất lúc: 2024-12-17 10:30:03