Job Description
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
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
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
Fraud, Waste and Abuse
• Identify and evaluate potentially fradulent claims and claims wastages and abuses and taking appropriate action to reactify the anomalies
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
Job Requirement
- 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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