Health Claims Supervisor

3 days ago

Makati, Philippines AXA Full time

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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.

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