The Life and Health Operations (LHO) department plays a pivotal role in ensuring we provide our customers with affordable and comprehensive life and health products, with efficient processes to allow optimal service to our customers.
As an Executive, you will report to the Life Claims Section Lead, manage health/minor claim assessment (including managed healthcare system) and handle administrative duties.
Key responsibilities include:
- Assess policy liability, compute and determine the claim amount payable based on policy cover and management guidelines for claim types such as minor claims of individual personal life insurance and managed healthcare system etc.
- Recommend payment or rejection of claims, ensuring timely and fair settlement of claims
- Ensure that claims are settled within the target time set and pending claims are reviewed within the target period
- Ensure that claims are processed in accordance to the service level agreements set within the organization and with external bodies such as CPF Board, vendor for panel clinics
- Work closely and maintain good rapport with representatives (financial consultants, advisers, brokers, etc.), officers and staff of other departments
- Communicate effectively with claimants and related parties, reinsurers, and external stakeholders such as the CPF Board, and hospitals, clinics, nursing homes, vendor for panel clinics in the course of claims administration
- Handle claim enquiries, service recovery, complaints, appeals and customer care matters
- Review and suggest process improvements for developing or implementing best practices
- Participate in operation efficiency and A.I. driven projects to bring efficiency to claims processes
- Undertake any projects or duties, including administrative duties, as assigned by Section Lead or Head of Function
Qualifications
- Diploma or Degree holder with 1 year of experience in Claims or Underwriting
- Good background in health claims
- Good policy language skills enabling accurate and consistent policy wording interpretation
- Good critical thinking skills and ability to handle complex computations
- Good written and communication skills, committed team player
- Meticulous with good analytical and administrative skills
- Able to multi-task and work independently
- Ability to work under pressure and manage deadlines
- Customer centric
