Head Of Benefit Claims
3 weeks ago
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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