Assistant Manager, Global Claims Control (Insurance / $6K) (ID : 685514)

Roles & Responsibilities

The incumbent will be responsible for providing medical advice in terms of claims insurance adjudication, supported by the reinsurers’ Chief Medical Officer where appropriate and to make decisions and recommendations on complex medical claims / high value claims (including Controlled Claims referred by Partners), within the delegated authority given to company by each reinsurer.

The role will also support product development and design for existing and new Insurance Clients in particular with regards to Policy Wording and Claims Practices including the delivery of operational processes and claims related training.

1.  Medical Advice, Controlled Claims and Claims decisions

• Ensuring that all Controlled Claims are duly authorised in accordance with Reinsurer contractual arrangements and that the required reporting is in place
• Preparation of Controlled Claims reporting for each Reinsurer and to EXCOM
• Handle claims cost management within the organisation by ensuring high standard of claims assessment

2.  Claims Audits

3.  Contribute and support all Partnership activity relating to claims activity such as :

4.  Fraud, Waste and Abuse

5.  Provide or assist in prevention and training to internal and external stakeholders

6.  Monthly reporting

7.  Require to be on standby to handle urgent claims approval after office-hour / weekend for one-week duration on monthly basis

Requirements :

Interested candidates who wish to apply for the advertised position, please click on “Apply”. We regret that only shortlisted candidates will be notified.

EA License No. : 01C4394 (PERSOLKELLY Singapore PTE LTD)

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TPA

Claims Handling

Cost Management

Healthcare

Audits

Fraud

Communication Skills

Nursing

Prevention

Product Development

Health Insurance

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