Manager, Service Account (Medical Claims) (Up to $8.5K) (ID : 605685)

Job Scope

• Control, manage and oversee claims and customer services delivery for the products distributed and serviced ensuring all contracted service levels and KPI’s are met
• Manage allernance Meetings with the Service Partner andpanies
• Ensure that there are no data breaches and that all agreed processes are met by the Service Partner
• Manage allplaints received from any stakeholder, ensure that they are resolved and reported with full service recovery in place
• Update Brokers and Agents on any enquiries received regarding claims
• Carry out regular reviews of all pending claims cases and ensure process improvements are put in place
• Ensure that the Service Partner is fully aware, and have embedded, any changes in guidelines, product changes and process updates
• Support and where necessary, manage Agent and Broker meetings
• Act as the key point for products reinsured, for all new product launches, projects and on-boarding of new customer groups
• Ensure that Service Levels for Customer Service and Claims Delivery are met
• Provide training to the Service Partner for customer service skills, claims adjudication protocols and product knowledge including validation testing and service skills
• Adjudicate claims and provide guidance on claims assessment to the Service Partner
• Deliver performance reports as required by the business
• Carry out claims analysis in order to present key statistics and information to the key stakeholders
• Ensure claims referred to Global Claims Control (GCC) are managed within 24 hours of receipt; provide approval and decline decisions in accordance with policy wording; provide additional guidance where more information is required
• Work closely with the Service Partner to assist in delivering customer service standards in line with their contractual obligations
• Ensure that the policies and procedures are in place to fully support the Service Partner so that they can deliver an optimised service
• Assist in the provision of training and support to the Service Partner on any area of service delivery as needed
• Oversight and management of the adherence to customer service protocols whether by voice or in writing to the customer and / or agent in line with agreed processes
• Excellent service delivery from the Service Partner – meeting all the agreed SLA’s
• Demonstrating the ability to handlemercial decisions as needed to respond to customer issues

Requirements