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Assistant Manager, Global Claims Control (Insurance / $6K) (ID : 685514) - D01 Cecil, Marina, People’s Park, Raffles Place, SG

PERSOLKELLY SINGAPORE PTE. LTD.D01 Cecil, Marina, People’s Park, Raffles Place, SG

2 days ago

Job description

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

Manage Claims Audits in accordance with the Annual Audit Schedule

Deliver Audit Reports to Clients and the business in accordance with company’s standards

Audits performed in accordance with the company’s Claims Audit Policy

Liaison and follow-up on Claims audit findings and implementation with auditees

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

Policy Wording design and interpretation

Provide Claims Training for Partners or TPA

Processes for the management of claims and controlled claims

Input in Policy Wording Forum

4. Fraud, Waste and Abuse

Identify and evaluate potentially fraudulent claims and claims wastages and abuses and taking appropriate action to rectify the anomalies

Tracked FWA for reporting purpose

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

Best practices on claims processing and guidelines

Claims case studies sharing

Claims-related medical topics sharing

6. Monthly reporting

Prepare monthly reports as required by management

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

Requirements :

Medical background with experience in nursing or allied health professionals are welcomed to apply

Strong knowledge of healthcare and insurance markets

Experience with health insurance claims handling

Good written and communication skills for effective claims handling toward all stakeholders

Reliable and trustworthy to handle assigned task in a responsible manner

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

Audit

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Assistant Manager • D01 Cecil, Marina, People’s Park, Raffles Place, SG