Health Claims Supervisor

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Job Description:

Directly responsible for the adjudication and approval of death, critical illness, TPD, Hospitalization benefit of all individual and group insurance claims within his/her approval limit and within the agreed turnaround time.Ensures that the life claims benefits are paid out in accordance with existing Philippine life insurance laws and statute.Assist in the resolution of complex claims cases and formulation of appropriate claims recommendation or decision where technical claims knowledge is required.Proactively manage and ensure timely resolution of customer and distributor claims-related issues including those raised in customer-specific platforms such as SCRM and AXA Angels.Ensure that life claims-related communications being sent to the internal and external stakeholders are appropriate and timely. Assist in regular updates of claims communications templates to ensure robust and dynamic claims communications across all platforms.Seamlessly coordinate with Claims Handler/Admin for the different processes which requires the role of the Claims Handler/AdminResearch required information using available resources. as well as Handle, manage, and resolve customer complaints.Following up on complicated customer calls where required.Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests. Escalate where necessary in accordance with claims guidelines and procedures.Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.Provide backup for any support functions in the office.Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.Accomplishes company goals by taking ownership of work responsibilities and constantly identify opportunities for work process improvement.Ensure legal compliance by following company policies, procedures, guidelines ad well as local insurance regulations and statute.Adhere to strict data protection compliance by keeping claims and sensitive medical information highly confidential.Promptly answer inbound calls from customers/distributors/providers who are looking to get a pre-approval for an availment/claim on a health policy.Accurately determine if a medical condition is a covered benefit based on the policy provisions, terms, and conditions.Seamlessly coordinate with Claims Handler/Admin for the different processes which requires the role of the Claims Handler/AdminResearch required information using available resources. as well as Handle, manage, and resolve customer complaints.Accurately document claim files with notes, evaluations, and decision-making processes based on departmental procedures.Utilize anti-fraud policies or protocols in place to mitigate fraud for submitted claims or pre-approval requests. Escalate where necessary in accordance with claims guidelines and procedures.Provide exceptional service and ensure a seamless customer experience by meeting defined customer experience targets.Provide backup for any support functions in the office.Accomplish tasks that may be assigned by his/her manager on an ad hoc basis.Ensure legal compliance by following company policies, procedures, guidelines ad well as local insurance regulations and statute.Adhere to strict data protection compliance by keeping claims and sensitive medical information highly confidential.

Qualifications:

Preferably a graduate of any medical or allied medical degree.At least 2 yrs experience in life, health and medical claims adjudication.Excellent written and oral communication skills with the ability to effectively articulate life insurance terms and conditions as well as the convey the reason for claims decision.Detail oriented and highly organized. Team player and at the same time efficiently do tasks in silo.Above average level of knowledge in insurance operational processes.Customer centric and must advocate the Customer First mindset.Highly developed sense of integrity.Pleasant, patient and friendly attitude; sociable personality. Able to relate to work colleagues from different backgrounds.Good negotiation and influencing skills.

A global leader in insurance and investments, AXA takes care of 103 million lives in 64 countries worldwide. We actively invest in pioneering and personalized solutions to meet your ever-changing needs and exceed your expectations. In the Philippines, we are in partnership with Metrobank, one of the country's strongest banks.

Established in 1999, AXA Philippines is one of the largest and fastest growing life insurance companies in the country. It offers financial security to more than one million individuals through its group and individual life insurance as well as general insurance products through its subsidiary Charter Ping An.

AXA Philippines is one of the first to introduce bancassurance operations in the country, and is among the pioneers in the investment-linked insurance sector.

AXA now offers a complete range of products for all its customers' insurance and financial protection needs, including savings and investments, health plans, income protection, and health coverage; and through its general insurance subsidiary Charter Ping An Insurance Corporation\: fire, motor car, marine cargo, personal accident, bonds, casualty, and engineering insurance products.

AXA Philippines closed 2017 with P26.4 billion in total premium income and P5.7 billion in gross written premiums from Charter Ping An. Today, AXA has more than 4,000 financial advisers in 36 branches, and 700 financial executives in over 900 Metrobank and PSBank branches nationwide. Charter Ping An, on the other hand, has 22 branches nationwide and 2,007 agents.

AXA Philippines is a joint venture between the AXA Group, headquartered in France, and the Metrobank Group, one of the largest financial conglomerates in the Philippines.

The Metrobank Group is a conglomerate of industry-leading businesses that includes First Metro Investment Corporation, Metrobank Credit Cards, Federal Land, Toyota, and Manila Doctors Hospital. It was hailed Best Bank in the Philippines in 2010, 2011, and 2012 by Euromoney and recognized as the strongest bank in the Philippines by The Asian Banker in 2013. It is owned by the Ty Family whose major business interests include financial services, real estate development, power, and manufacturing.

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