Health Claims Supervisor

1 week ago

Makati, Philippines AXA Full time

The provided job description contains comprehensive details about the role, responsibilities, and qualifications. However, it exhibits significant repetition, especially in the responsibilities and qualifications sections, which could be condensed to improve clarity and conciseness. Additionally, the formatting can be optimized to enhance readability and engagement by appropriately using HTML tags. Below is a refined version with improved structure and reduced redundancy, maintaining all essential information: Job Responsibilities Directly adjudicate and approve death, critical illness, TPD, and hospitalization benefits for all insurance claims within approval limits and turnaround times. Ensure claims benefits are paid in accordance with Philippine insurance laws and statutes. Assist in resolving complex claims and formulate appropriate recommendations or decisions requiring technical claims knowledge. Manage and resolve customer and distributor claims issues proactively, including those raised via platforms such as SCRM and AXA Angels. Communicate effectively with stakeholders, ensuring timely and appropriate claims-related communication. Regularly update communication templates for robustness across platforms. Coordinate seamlessly with Claims Handler/Admin for various processes. Research information using available resources, handle customer complaints, and follow up on complex calls as needed. Document claim files accurately, including notes, evaluations, and decisions, following departmental procedures. Apply anti-fraud policies to mitigate claims fraud, escalating issues as necessary. Provide exceptional customer service to ensure a seamless experience and meet customer experience targets. Support office functions as backup and undertake ad hoc tasks assigned by management. Identify opportunities for process improvements and ensure compliance with company policies, local regulations, and data confidentiality standards. Qualifications Preferably a graduate of medical or allied medical degrees. Minimum of 2 years' experience in life, health, and medical claims adjudication. Excellent communication skills, capable of articulating insurance terms and explaining claims decisions. Highly organized, detail-oriented, and a team player who can work independently. Strong knowledge of insurance operational processes. Customer-centric with a strong integrity ethic. Pleasant, patient, sociable, and able to relate well with colleagues from diverse backgrounds. Good negotiation and influencing skills. About the Company AXA SA is a French multinational insurance firm. #J-18808-Ljbffr

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