Claims & Operations Manager

Work Location: Central Region

Work Days: 5.5

Working Hours: Monday to Friday: 9 am to 6 pm

Saturday: 9 am to 1 pm

Job Responsibilities

I. Claims Management:

1. Manage and audit all claims forms and medical reports.
2. Liaise with clinics and hospitals regarding claims and medical reports.
3. Ensure Policy Holder's (PH) questionnaire and claim forms are completed and submitted to the Insurer on time.
4. Ensure pre- & post-hospitalization claims are filed with the Insurer promptly.
5. Monitor claim progress for each admission and/or case closely.
6. Maintain and update PH's claim summary.
7. Retrieve claims updates from hospitals and centers, PHs, or their Insurance Companies and upload them to the Company Connect Portal.
8. Provide claims status updates to stakeholders through the respective channel.
9. Update the final bill and claim closure.
10. Pre-assess each case submission and audit the Estimated Claim Spreadsheet (ECC).
11. Study various health insurance products and monitor claim assessment and approval trends for different products.
12. Participate in improving claims submission and management processes.
13. Provide claims advice to the Business Development Team.
14. Conduct monthly claims review meetings monthly and generate ad-hoc reports when required.
15. Train and manage junior claims associates to meet claims department KPIs consistently.

II. Operations:

1. Ensure the operation process is smooth and seamless by overseeing and auditing the processes below:
2. Supervise the operation process for quality control and participate in improving the company sales operation process.

III. Data & Systems Management:

1. Update and ensure the accuracy of the information, including, but not limited to, details of PH, admission, discharge, procedure, surgical code/table, and insurance policy for each entry.
2. Ensure PH's information, medical reports, bills, and claim submissions are filed adequately into the system according to the Company's protocol.
3. Assist and participate in system improvement.

IV. Others:

1. Organize, schedule, and/or assist with company meetings and events.
2. Take accurate meeting minutes and ensure proper documentation filing.
3. Perform other ad-hoc duties assigned by seniors and management, especially during and/or after office hours.

Job Requirements

1. At least 3 years of experience handling health and personal accident claims.
2. Strong relationship management skills and interpersonal and communication skills, both written and verbal.
3. Ability to understand and resolve issues effectively.
4. Adaptable, resilient, able to multitask, and work well in a dynamic and fast-paced environment.
5. Confident and passionate about customer service quality.
6. Resourceful, proactive, and analytical with an eye for detail.
7. A good team player, meticulous, organized, highly adaptable, and flexible in supporting all ad-hoc duties.
8. Protect information security and provide responses to queries prompt and detail.