Claim Manager

The role we are hiring for
We are seeking a Manager, Claims who is responsible for leading the claims team in ensuring accurate and timely administration of claims.
The ideal candidate will have a mindset of continuous improvement and change and will demonstrate curiosity, collaboration and the ability to deal with ambiguity especially in a start-up environment.
This role reports directly to the CEO
A summary of the key responsibilities and requirements are as follows:
Responsibilities
• Demonstrate thorough understanding of health technical claims assessment and processes
• Ensure accurate and timely assessment of health claims within the required service standards
• Monitor and manage timely closure of outstanding claims
• Handle claim enquiries, service recovery, complaints, appeals and other customer care matters
• Perform claim peer review inspection for claims exceeding assessor's authority limit
• Review and prepare claims SLA reporting as per stipulated timeline
• Conduct health technical claims assessment and training for new joiners
• Manage work relation with external parties such as medical institutions, clients, etc
• Manage key internal stakeholders such as claims, network management teams etc. to ensure all service level agreements are met
• Participate in operation efficiency and A.I. driven projects to bring efficiency to claims processes
• Review onboarding process for new accounts i.e acts as Subject Matter Expert (SME) for claims and identify any gaps relevant to claims
• Plan, co-create, execute, evaluate and improve Standard Operating Procedures (SOPs) and guidelines for daily operational work processes
• Manage other ad-hoc projects as assigned from time-to-time