Claim Officer (Medical Doctor - Healthcare)

PURPOSE:

• Building claims guidelines and procedures for health claims to enhance expertise for prompt and accurate assessment and excellent services.

• Ensuring claim assessments are accurate and in strict compliance with the terms and conditions of the contract, while also considering equitable and reasonable factors within the permitted limits to satisfy the customer.

• Creating effective training programs of medical, underwriting & assessment for claim assessors.

• In charge of quality control & quality assurance duties.

2. ACCOUNTABILITIES:

• Delivering prompt, accurate claim assessments and excellent service to health claims in accordance with Claims Department’s guidelines and procedures.

• Approving health claims as per prescribed authority limits; resolving complex claims and/or developing recommended solutions based on good judgment, initiative and technical skills.

• Supporting department targets and company objectives as and when assigned by the line manager such as building training programs, and being in charge of quality assurance & quality control.

• Collaborating and maintaining good relationships with cross departments/functions to smoothly solve all claims-related issues and reach claims objectives.

3. REQUIREMENTS

Education and Experience

• Medical doctor or equivalent, preferably in the insurance field.

• Experience in life insurance underwriting is preferable.

Technical skills

• Strong knowledge of claim operations & processes

• Emotional intelligence

• Analytical thinking

• Identifying and problem-solving

• Negotiation for results.

Soft skills

• Proficiency in Microsoft Office (Work, Excel...)

• Teamwork

• Effective time management

• Collaborative

Personal attributes

• Careful

• Proactive

• Enthusiastic

• Integrity

4. CHALLENGES

• Ensure that all claims are handled promptly and effectively with agreed service standards ;

• To ensure re-underwriting and claim assessments are accurate, and to be flexible in decisions to satisfy customers within allowable limits

• Work under high pressure.