Job Purpose
The Senior Expert, Claims, will play a critical role in setting up and managing the claims function for a newly established life insurance company. This role is responsible for developing claims processes, defining Standard Operating Procedures (SOPs), collaborating with IT to implement claims management systems, working with reinsurers on claims policies, and establishing strong partnerships with third- party service providers such as medical panels and claims investigators. The Senior Expert, Claims, will also work closely with Techcombank to integrate data insights and ensure a seamless claims experience for customers.
Key Responsibilities
Claims Process Setup & SOP Development
- Design end- to- end claims workflows, from claim submission to assessment, approval, and payment.
- Develop and implement Standard Operating Procedures (SOPs) for claims processing, ensuring efficiency and compliance.
- Ensure alignment of claims processes with regulatory requirements and industry best practices.
Collaboration with IT & Digital Transformation
- Define business requirements for IT teams to implement a digital claims management system.
- Ensure seamless integration of claims processing with policy administration and customer service platforms.
- Work with IT and digital teams to integrate claims automation tools and AI- driven claims assessment models.
Claims Risk Management & Reinsurance Coordination
- Work closely with actuarial and underwriting teams to ensure claims trends inform future risk assessment strategies.
- Collaborate with reinsurance companies to define claims handling guidelines and facultative claims assessment.
- Establish governance frameworks for claims risk monitoring and fraud detection.
Stakeholder Engagement & Collaboration with Techcombank
- Work on data integration between Techcombank and the insurance company to ensure smooth claims verification and settlement.
- Provide training and support to distribution teams on claims procedures and fraud detection measures.
- Engage with Techcombank’s distribution and risk teams to develop claims service standards that meet customer expectations.
Collaboration with Third- Party Service Providers
- Establish and manage relationships with third- party medical panels, hospitals, clinics, and claims investigation firms.
- Negotiate and monitor service level agreements (SLAs) with external partners to ensure high- quality claims services.
- Ensure that external medical evaluations and claims assessments support the company’s risk management objectives.
Customer- Centric Claims Experience
- Implement digital solutions to allow self- service claims submission, tracking, and updates for customers.
- Continuously monitor claims turnaround times and propose improvements to enhance customer satisfaction.
- Develop a customer- friendly claims process that balances risk management with a smooth and transparent experience.
Performance Monitoring & Continuous Improvement
- Define and track key performance indicators (KPIs) for claims processing efficiency, fraud detection, and settlement ratios.
- Analyze claims data to identify trends, potential risks, and areas for process optimization.
- Ensure that claims policies evolve based on claims experience and market trends.
