Head of Claim

Responsibilities

1. Lead the claims resolution strategy and oversee all aspects of the claims process, including assessment, handling, adjustment, settlement, investigations, litigation, and recovery.
2. Lead transformation in claim management's operational area that focuses on strong governance, streamlined process, cost-effectiveness and user-oriented digital solutions to improve customer experience in the claim process.
3. Analyse claims trends and industry data to ensure high-impact operating results and fair outcomes for customers.
4. Develop customer service strategies, within claims, to provide exceptional customer experiences and market-leading service excellence.
5. Build, expand and maintain good relationship with TPA and Provider (Local and Overseas) and periodically evaluate the business agreement with providers to improve cost control, maximize service delivery, and provide customers best-in-class Claim services.
6. Carries out the assessment and settlement of life, health, disability, and pension insurance claims arising from policies in force and makes policy recommendations for claims handling and guidelines for claims processes.
7. Liaises with solicitors and other third parties to seek guidance on the course of action of best interest to the company during claims investigation and cases.
8. Manage and monitor the claim investigation process on claim cases by examining claims data and facts to ensure the resolution of Claim investigation and Claim cases.
9. Build a knowledgeable team and oversee their learning and development to ensure effective succession planning and communication of key imperatives.
10. Act as medical advisor for the internal company.
11. Provides leadership by giving direction, coaching and/or mentoring, and performance monitoring to the subordinate to ensure the development of personnel and productivity of personnel is achieved and alongside Human Capital resolve workforce management processes and needs such as recruitment, development, performance management, and Employee’s grievance

Qualifications

1. Bachelor degree from Faculty of Medical
2. 10 years experience as a Claim Sr. Manager/AVP
3. 5 years experience as a Claim (VP, General Manager) and proven experience in managing end-to-end claim processes and leading transformation focusing on customer centricity to improve claim process effectiveness and customer experience.
4. Preferable have experience in Joint Venture Life Insurance Company
5. Strong understanding of life insurance terms and conditions and claim appeal process.
6. Strong analytical skills.
7. Excellent communication, negotiation, and relationship building skill
8. Proven experience in claims strategy and leading claims transformation.