Head of Claim - Health & Benefits

This job is with WTW, an inclusive employer and a member of myGwork – the largest global platform for the LGBTQ+ business community. Please do not contact the recruiter directly.

Description

The Head of Claims for Employee Benefits in an insurance brokerage oversees the management of claims related to employee benefits programs, such as health, life, and disability benefits. This role requires a blend of leadership, technical expertise, and client service.

The Role

• Lead the claims team responsible for employee benefits claims. This includes managing staff performance, providing guidance, and ensuring the department meets service level agreements and regulatory standards.
• Oversee the entire claims process for employee benefits, ensuring that claims are processed efficiently and fairly. This includes working with insurance carriers to expedite claims resolution and ensure compliance with policy terms.
• Serve as the main point of contact for employers regarding claims issues. Provide expert advice on claims-related inquiries and work to resolve any client concerns. Ensure that clients are kept informed throughout the claims process.
• Handle complex or escalated claims, negotiating with insurers, healthcare providers, and legal teams when necessary. Work to resolve disputes or issues that may arise during the claims process.
• Ensure that all claims handling complies with local regulations and other relevant laws. Stay updated on regulatory changes affecting employee benefits claims.
• Provide regular reports to Clients on claims performance, identifying trends and making recommendations for improvement. This can also involve analyzing claims data to identify potential cost-saving opportunities for clients.
• Work closely with the benefits consulting and underwriting teams to provide insights on claims experience, assist with renewal negotiations, and help tailor benefits packages based on claims trends.
• Build and maintain relationships with insurers and third-party administrators (TPAs) to ensure efficient claims handling and resolution. Negotiate favorable terms where necessary.
• Assist employers in understanding the claims process and their employees’ benefits, providing training or materials to help them navigate the system effectively.
• Continuously review and improve the claims handling processes to enhance client satisfaction and operational efficiency. Explore innovative solutions such as digital claims handling or automated claims systems.
  
  

Qualifications

The Requirements

• Min. Bachelor's Degree
• Microsoft Office literacy
• Min. 3 years working experience at similar role in Insurer’s Claim Department, Third Party Claim Settlement Company
• Good communication & problem solving skills
• Client-oriented, innovative and critical sense
• Good presentation and negotiation skill
• High integrity
• Be able to work under high pressure
• Long-term commitment
• Excellent English in both writing and oral
  
  

Equal Opportunity Employer