Manager, Regional Claims Service (Global Healthcare Insurance)

Job Highlights

Job Description

  • 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.

Requirements:

  • 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.
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