Claims Assessment Manager

- Delivering excellent judgment, prompt, accurate claim assessment and excellent service to Healthcare claims in accordance with Claims Department’s guidelines and procedures;

- Managing of TPA in claims assessment to meet Service Level Agreement (SLA), control quality of claim assessment;

- Proposing, initiating and managing operations of team to ensure the team’s activities smoothly executed in accordance with the Company principle and guidelines; monitoring quality and productivity of Claims staff to ensure fast and accurate assessment as Claims guidelines and cost efficiency. This team is setup as a foundation of Core Healthcare members to support building Healthcare services;

- Recruitment and providing training courses to team members to ensure the skills and knowledge developed effectively;

- Assessment claims as per prescribed authority limits; resolving complex claims and/or developing recommended solutions based on good judgment, initiative and technical skills;

- Building and maintaining excellent relationship with hospital, clinic networks and government offices, managing the Hospital/clinic and TPA/partner networks to provide excellent and effective service to customers;

- Duties to support Division targets and Company objectives as and when assigned by Line Manager;

- Cooperation with other Departments such as CS, Underwriting, IT, Agency... etc. to smoothly solve all claims-related issues and reach claims objectives.

Job specification:

1. EDUCATION / TRAINING

University Degree; English intermediate is preferred

2. PROFESSIONAL / TRADE QUALIFICATION

Insurance, Business

3. COMPETENCIES

Honesty, carefulness, hard-working, be able to work under high pressure

Critical thinking; Problem solving skill; People management; Project management

4. EXPERIENCE

Having experience at least 5 years in insurance and at least 3 years in Healthcare insurance

Medical Knowledge is a plus

Experience in negotiation with Medical Facility representatives to expand Panel Network

5.COMPUTER PROFICIENCY

MS Office

6. KEY WORKING RELATIONSHIP

Good attitude and respect colleagues

Team work