Head Of Benefit Claims

17 hours ago


Metro Manila Philippines Buscojobs Full time

Job Description

Job Title: Head of Claims Department

Responsibilities

  • Lead and manage the end-to-end claims process to ensure timely, fair, and efficient resolution in line with target turnaround times.
  • 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.
  • Prepare reports and analyze data to identify trends and areas for improvements; ensure 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.
  • Serve as the primary liaison between clients, adjusters, and insurance companies / representatives to ensure the necessary support for effective claims settlement.
  • Collaborate with the Marketing team to identify business opportunities and expand services to existing clients through claims-related touchpoints.
  • Perform other duties and responsibilities as may be assigned by the immediate supervisor or authorized senior management.
  • Stakeholder Coordination: Coordinate effectively with adjusters, and other service providers to support timely claims resolution.
  • Client Support: Assist clients in completing claims requirements within agreed-upon turnaround times, ensuring a smooth process and clear next steps.
  • Systematic Monitoring: Ensure the claims monitoring system is regularly updated with real-time data for accurate reporting and analysis.
  • Escalation of Issues: Promptly report any major or potentially problematic claims to Senior Management with a recommended course of action.
  • Stakeholder Engagement: Conduct regular meetings with clients, adjusters, insurers, and internal teams to align on expectations and address issues.
  • Program Development: Recommend and execute enhancements to the claims management program to improve process efficiency and client outcomes.
  • Client Communication: Provide timely and transparent feedback to clients regarding the status and outcomes of their claims.
  • Lead Generation for Marketing: Identify and relay potential business leads to the Marketing Department based on insights from client servicing activities.
  • Client Relationship Management: Conduct regular check-ins with clients to assess satisfaction with the Claims team\'s performance and explore cross-selling opportunities.
  • Other Duties: Fulfill additional responsibilities as may be assigned in support of departmental and organizational goals.

Location restrictions: This description does not include or reflect region-based hiring requirements beyond the text provided.

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