Assistant Manager, General Insurance Claims

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About the Role

Responsible for determining the validity and authorising settlement of group health insurance claims

Duties :

• Pro-actively handle claim cases, including timely investigation into suspicious abuse claims, cost-effectiveness engagement of service providers, regular claims follow up, provide guidance and coaching to subordinates on claims, insurance / risk issues and performance;
• Assess, handle and approve all claims types and authorize claims payment within authority and refer claims beyond authority to the Head of Claims / Manager providing sound recommendations;
• Draft effective correspondence for complex coverage positions;
• Handle claims appeals, complaints, reinsurance / third party recovery claims in the best interest of the Company;
• Work with the Head of Claims / Manager to monitor and conduct assessment of service providers for effective investigation / litigation / recovery management;
• Assist in reports preparation / automation;
• Actively participate in the team’s meeting, enhancement of workflow, claims system, UAT and projects;
• Interface with related departments and relevant parties on projects and joint work to enhance customer service experience;
• Obtain and maintain license as an individual insurance agent of Blue Cross with the Insurance Authority, and, where necessary, upon successful licensing as individual insurance agent with the Insurance Authority, advise on or arrange contracts of insurance or carry on regulated activity.

Education / Work Experience