Head of Insurance Claims Management (Health/Medical)

Head of Insurance Claims Management (Health/Medical)

eTeam Inc
Hong Kong
0 - 0 Years
Not Specified

Job Description

Position:- Head of Insurance Claims Management (Health/Medical)
Position Type:- Permanent

To be considered for this role, you should ideally have :-
  • Bachelor degree or qualifications in medical professional
  • Minimum 10 years solid experience and 7 years in leading people in claims or pre-authorization functions
  • Solid experience in health insurance claims management
  • Background in medical or relevant transferable skills and knowledge from other financial services industries is preferred
  • Multi-tasking, with strong sense for looking at innovative means to improve operations efficiency and customer experience
  • Excellent leadership, interpersonal and influencing skills
  • Strong analytical, problem solving and decision making skills
  • To be customer focus and committed to deliver high quality services
  • High levels of integrity, trust and independency 
Accountabilities and Activities :
  • Manage and oversee the operations of claims and case management department to meet operations, productivity, quality & control and services requirements
  • Establish proper procedures and policies to be utilized throughout the life cycle of claims resolution and pre-authorization process
  • To be responsible for strategic processing and payment / approval of claims and pre-authorization cases
  • Identify employee/team objectives, manage associated plans and provide guidance to subordinates in claims and case management team
  • Regularly analyse the workflow process of entire department in consideration of emerging technology, identifying opportunities to operate claims and case management organization more efficiently
  • Keep abreast of any changes to legislation and regulations which pertain to insurance claims and ensure company goals are met in conjunction with compliance of legal requirements
  • Address and resolve elevated customer complaints regarding claims and case management related issues
  • Review management reports and implement corrective actions identified
  • Prepare for and participate in audits and compliance review and ensure the operations procedure is in compliant to the set rules and regulations
  • Maintain open communication channel with other departments and management, including but not limited to Underwriting, Finance, People and IT teams
  • Keep the Operations and Business Transformation Director informed with reference to developments in claims and case management trend that substantially affect our business
Remarks:
  • Claims operations leading team
  • Doing transformation claims department
  • Manual work
  • Department for transformation
  • Different parties
  • Within or outside operations IT and support
  • Report to COO
  • Work close with COO and MD
  • Strong in communication
  • Coordination on different
  • Check website on website
  • Claims and preapproval management
  • Both teams and managers day to day on operations.
  • Language: English okay
  • Locally available in HK
Saif Ali Ahmed
Senior Technical Recruiter (APAC)
Phone:+852 3703 8456
Feel free to reach me for an question/query.

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