The Role
The incumbent will be responsible for providing medical advice in terms of claims insurance adjudication, supported by the reinsurers’ Chief Medical Officer where appropriate, and to make decisions and recommendations on complex medical claims/high value claims (including Controlled Claims referred by Partners), within the delegated authority given.
Furthermore, to support product development and design for existing and new Insurance Clients, in particular with regards to Policy Wording and Claims Practices including the delivery of operational processes and claims related training.
Main Responsibilities
1. Medical Advice, Controlled Claims and Claims decisions
• Ensuring that all Controlled Claims are duly authorised in accordance with Reinsurer contractual arrangements and that the required reporting is in place
• Preparation of Controlled Claims reporting
• Handle claims cost management within the organisation by ensuring high standard of claims assessment
2. Claims Audits
• Manage Claims Audits in accordance with the Annual Audit Schedule
• Deliver Audit Reports to Clients and the business in accordance with company's standards
• Audits performed in accordance with the Claims Audit Policy
• Liaison and follow-up on Claims audit findings and implementation with auditees
3. Contribute and support all Partnership activity relating to claims acitivity such as:
• Policy Wording design and interpretation
• Training claims processes
• Processes for the management of claims and controlled claims
• Input in Policy Wording Forum
4. Fraud, Waste and Abuse
• Identify and evaluate potentially fradulent claims and claims wastages and abuses and taking appropriate action to reactify the anomalies
5. Provide or assist in presention and training to internal and external stakeholders
• Best practices on claims processing and guidelines
• Claims case studies sharing
• Claims-related medical topics sharing
Requirements
- Strong knowledge of healthcare and insurance markets
- Experience with health insurance claims handling
- Possess the drive and determination to set, meet and improve upon the highest standards of performance.
- Able to work co-operatively and collaboratively with others to achieve business goals
- Understand the customers’ needs to deliver quality work in an efficient and efficient manner.
Interested candidates who wish to apply for the advertised position, please click on “Apply”. We regret that only shortlisted candidates will be notified.
EA License No.: 01C4394 (PERSOLKELLY Singapore PTE LTD)
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