Head of Benefit Claims

4 weeks ago


Makati, Philippines ETIQA LIFE AND GENERAL ASSURANCE PHILIPPINES, INC. Full time

The Head of Benefit Claims will oversee the end-to-end process of Medical, Life and Non-Life Claims, ensuring timely and accurate reimbursement to our members. All Claims should be processed within the agreed turn-around-time with our corporate clients or as stated in the contract for individual clients. His/her expertise will drive process improvements, team development, and stakeholder management.

  • Manage the end-to-end process of medical, life and non-life claims, ensuring accuracy, efficiency, and compliance with regulations and company policies

  • To check / approve if adjudicated claims are based on contract provisions. To approve request for payments. To make sure that claims are paid within TAT

  • Monitor day-to-day performance, conduct spot audits, and ensure accurate and timely processing of claims

  • To see to it that reply to email inquiries are done within 24 to 48 hours for regular inquiries and within the day for urgent emails

  • Prepare reports and analyze data to identify trends and areas for improvements

  • To see to it that required reports are sent within SLA

  • Develop and implement strategies for efficient end-to-end claims processing, ensuring prompt resolution of escalated cases and complaints

  • Collaborate with medical providers, brokers, and other stakeholders to resolve complex claims

  • Ensure claims processes adhere to relevant laws, regulations, and industry standards

  • Develop and track key performance indicators (KPIs) to measure team performance and process effectiveness

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