Manager, Regional Claims Service (Global Healthcare Insurance)
- Control and manage high value and complex claims referred from either the service account managers or partners.
- Provide medical advice or claims decisions based on policy wording interpretation as necessary. Conduct medical review for cases in doubt or when a previous claim decision is challenged.
- Responsible for claims cost management by identifying and evaluating potentially fraudulent claims or claims wastages and abuses and taking appropriate action to rectify the anomalies.
- Audit the claims payment decisions and adherence to processes made by the service account managers, the TPAs and partners.
- Prepare audit reports with recommended corrective action and work with the team members to drive the recommendations through and ensure actions are delivered.
- Oversee and validate controlled claims referral.
- Respond to queries from partners on product or claims related matters.
- Support the training to the service account managers and the staff at TPAs or partners.
- Provide feedback to the products team on claims related issues such as policy wordings challenges. Support on-going new business and product development as required.
- Oversee the IEMA operations as provided by the assistance companies for on-going cases.
- Medical or Nursing qualification/background is advantageous for this role.
- At least 5 years of experience in handling health claims at a Managerial level. Able to identify fraud, waste and abuse in health claims.
- Meticulous and driven to meet high standards of performance.
- Ability to influence the key stake holders, drive and communicate a compelling vision which energises and motivate others.
- Flexibility and adaptability to changes.
- Ability to take the initiative and identify what needs to be done, taking action to ensure it is completed.
- Ability to work well with others to achieve business goals.
- Ability to develop training materials and deliver training according to the needs of the audience.