Health Insurance Claim Head

Job Description

• Lead the Employee Benefit Insurance After Sale team including Data and Claim team
• Responsibilities of After Sale team include processing claims, assist clients with endorsements, documents and data keeping
• Oversees insurance claims that are in progress to make sure claim decision come out according to SLA and claim appraisal result is justified according to the agreed TC
• Assist clients who are admitted to hospital by coordinating with insurance and hospitals when necessary
• Make daily, weekly, and monthly report for claim updates
• Customer care helpline – 24 hours
• Develop and maintain relationships with insurance companies’ claim departments
• Negotiate and appeal rejected claims with insurance
• Monitor endorsement process and make sure SLA is achieved
• Check and make sure member cards are correct and send them to the clients on time
• Assist with client closing process by coordinating with insurance and making sure the policy T and C is as per agreed
• Put in place control mechanisms that enable achievement of high levels of customer satisfaction.
• Ensure quality and service excellence to clients and 5/5 client satisfaction
• Continuously improve current systems and processes
• Promote a culture of high performance and continuous improvement that values learning and commitment to quality.

Qualifications

• More than 5 years experience as Claim Manager in insurance or brokerage firms
• Have good relationships with insurance companies
• Excellent in communication, negotiation, and persuasion skills
• Strong adherence to SLA and maintaining clients expectations
• Able to respond to clients inquiry with lightning speed and accuracy
• Strong understanding of insurance terms and conditions and claim appeal process
• Background in medicine is preferred but not a must

Additional Information