Head of A&H Claims

Job Description

• Coordinate with relevant stakeholders to provide best customer service
• Approve claims within authority & establish fair practices in claims settlement in terms of claim genuineness, liability & breakdown assessment
• Keep stakeholders informed on the progress of the claim
• Update necessary claim information into database & ensure staff’s accuracy in data-entry
• Ensure claims operation is in compliance to regulatory guideline
• Provide necessary support in accordance to Company’s directive
• Manage fraud, safeguard Company’s interest by acting on leakages and ensure accurate liability assessment
• Provide report on TAT, outstanding & irregularity listing to HOD on weekly basis with action plan
• Handle and manage authority regulatory matters and complaints within timeline
• Ensure departmental KPIs meet management requirement
• Conduct check & balance & monitoring within internal & external processes
• Perform quarterly evaluation on panel vendors
• Conduct necessary training & transfer of job knowledge on regular basis
• Analyze claims & report to HOD on any irregular trends & malpractices & correct recoveries from all parties
• Ensure claim cases with large amount has been informed to re-insurer and comply with company retention (if any)
• Ensure Cash Calls & XOL’s are monitored & made in timely manner (if any)
• Administer best practices & smooth day-to-day operation
• Prepare necessary reports as required by HOD
• Handle any other portfolio as required by management

Job Qualification

• Bachelor degree or higher, preferably in nursing science.
• Knowledgeable in health and accidental claims.
• At least 5 years of insurance experience.
• Be reliable and skilled in communicating.
• Good analytical skills.
• Strong leadership.
• Self-starter with readiness to groom the team towards service excellence.
• Computer literate with focus on process & system improvement.
• Good command of spoken and written English.

Last updated on Sep 16, 2024