Senior Officer, Claims Handling (Techcom Life)

JOB PURPOSE
Plays a critical role in executing high- quality claims operations, providing technical expertise for complex cases, ensuring procedural transparency and regulatory compliance, and working closely with cross- functional teams to deliver a customer- centric claims experience.
KEY ACCOUNTABILITIES
Key Accountabilities (1)
Technical Claims Operations
- Collaborate with the medical review unit to interpret complex health records or lab results that may impact payout decisions.
- Identify exclusions, disputes, or risk indicators within claims files and recommend resolution strategies or escalation actions when appropriate.
- Propose enhancements to forms, evaluation checklists, and expert commentary frameworks to streamline decision- making and improve accuracy.
- Draft professional, transparent customer and agent correspondence for cases requiring clarification, additional verification, or declined outcomes, aligning with company policies.
- Maintain secure records and contribute to internal case libraries by documenting notable technical issues and best practices for team reference and training."
- Work jointly with Legal to assess claims involving beneficiary disputes, fraud risk, or confidentiality restrictions.
- Track operational KPIs such as average turnaround time, supplemental documentation requests, and rejection rates, offering insights to optimize performance and reduce complaints.
- Perform technical assessments of complex claims, including death benefits, critical illness, accident coverage, and waiver- of- premium cases, with thorough review of policy terms and supporting documents.
- Provide technical guidance to junior staff and peers on handling special cases or incorporating updated product or policy criteria.
- Serve as an internal quality reviewer (peer reviewer) for cases flagged for potential fraud, discrepancies, or requiring in- depth evaluation.
- Support data reconciliation efforts between paper documentation and system entries, ensuring consistency for internal audit and reinsurance purposes.
- Validate key documents such as medical records, death certificates, accident reports, and legal statements, ensuring compliance with the benefit conditions.
Key Accountabilities (2)
Internal Collaboration
- Join internal innovation teams focused on streamlining workflows, strengthening document handling, and delivering superior claimant experience.
- Offer ideas to simplify coordination steps across departments, especially in document handover, internal approvals, and customer data verification processes.
- Collaborate effectively with departments such as Underwriting, Product, Customer Service, IT, and Legal to resolve complex cases with consistent and aligned information flow.
- Participate in testing new tools (evaluation systems, claims software), providing feedback based on daily operational experience to improve usability and reliability.
- Actively maintain and grow technical expertise through internal documentation, knowledge- sharing sessions, recurring training, and exposure to process optimization initiatives.
- Support the creation of internal reference documents, including guides for exceptional cases, response templates, and claims evaluation checklists.
- Mentor and assist junior or less- experienced staff in handling specialized claims cases, strengthening overall team capabilities.
- Join recurring technical meetings with management and cross- functional teams to share updates, analyze case examples, and contribute specialist insights to workflow enhancement.
- Help nurture a professional and collaborative working environment that encourages learning, sharing, and personal growth within the Claims team.
- Serve as a subject- matter contact point for non- technical departments (e.g. Sales, Customer Service) when claims- related inquiries arise involving benefit eligibility, resolution mechanics, or legal obligations.
Key Accountabilities (3)
Quality control and process improvement
- Collaborate with claims system developers to recommend UI adjustments, improve record retrieval features, or add approval support tools.
- Participate in internal peer audits across claims teams to harmonize processing standards and ensure consistent quality across functions.
- Analyze common processing errors or discrepancies to identify root causes and recommend corrective actions to minimize recurrence.
- Share real- world claims handling examples in improvement workshops and offer professional perspectives to challenge or refine proposed workflows.
- Recommend updates to technical checklists, instructional templates, and case triage workflows to promote clarity, consistency, and reduce systemic missteps.
- Propose implementation of technologies such as automated alerts for missing documents, dashboard- based risk data analysis, and integration with external verification APIs.
- Monitor customer feedback related to transparency, resolution time, and service response quality, and suggest enhancements to meet evolving service expectations
- Assist management in compiling quality control data, identifying operational trends, and preparing periodic reports for internal reviews or external audits.
- Contribute to the development of product- specific evaluation guides, categorizing claims by benefit type and risk level to promote specialized case handling.
- Conduct periodic reviews of processed claims to ensure procedural compliance, document completeness, and accuracy in applying benefit terms, particularly in complex or sensitive cases.
- Promote a team- wide quality culture through sustained accuracy, peer- to- peer review practices, and constructive feedback loops.
- Support onboarding and internal training programs focused on quality assurance, educating peers on error identification and correct procedural application.

Social insurance, health care insurance, loan, etc….
13th month salary, performance bonus

Cập nhật gần nhất lúc: 2026-01-28 06:10:02