Head of Claim
3 days ago
Job Description:
- Monitor and ensure claim process within agreed TAT, policies & procedures, and company regulations.
- Make decision on claim payment within authority limit.
- Ensure all reports related to claims, including analysis, are submitted within agreed deadlines and claim procedures.
- Check claim guidelines and procedures in Claim and Provider Relations.
- Monitor and provide responses regarding complaints related to claims.
- Monitor and ensure TPA (Third Party Administrator) processes are in accordance with agreements, and support TPA in assuring decisions on coverage & GL.
- Support the development and revamp of policy wording.
- Visit hospitals/clinics to offer cooperation as Great Eastern Life Indonesia Provider.
- Conduct socialization on the procedure to hospitals/clinics.
- Support Group Sales and Brokers related to the claim process.
- Involve in Claim Projects or related operations.
- Conduct quality checking/assurance of Claim Analysts, TPA, and other hospital provider services in alignment with company and departmental SOPs, guidelines, and regulatory requirements.
- Coordinate with other departments to review and monitor claims, including claim data analytics and claim patterns for possible abuse/fraud claims.
Requirements:
- Bachelor's degree from the Faculty of Medical.
- 10 years' experience as Head of Claim.
- Proven experience in managing end-to-end claim processes and leading transformation focusing on customer centricity to improve claim process effectiveness and customer experience.
- Preferably experienced in a Joint Venture Life Insurance Company.
- Strong understanding of life insurance terms and conditions and the claim appeal process.
- Strong analytical skills, excellent communication, negotiation, and relationship-building skills.
- Proven experience in claims strategy and leading claims transformation.
Associate
Employment TypeFull-time
Job FunctionHealth Care Provider
IndustriesInsurance
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