Health Insurance Claim Head
- Lead the Employee Benefit Insurance After Sale team including Data and Claim team
- Responsibilities of After Sale team include processing claims, assist clients with endorsements, documents and data keeping
- Oversees insurance claims that are in progress to make sure claim decision come out according to SLA and claim appraisal result is justified according to the agreed TC
- Assist clients who are admitted to hospital by coordinating with insurance and hospitals when necessary
- Make daily, weekly, and monthly report for claim updates
- Customer care helpline – 24 hours
- Develop and maintain relationships with insurance companies’ claim departments
- Negotiate and appeal rejected claims with insurance
- Monitor endorsement process and make sure SLA is achieved
- Check and make sure member cards are correct and send them to the clients on time
- Assist with client closing process by coordinating with insurance and making sure the policy T and C is as per agreed
- Put in place control mechanisms that enable achievement of high levels of customer satisfaction.
- Ensure quality and service excellence to clients and 5/5 client satisfaction
- Continuously improve current systems and processes
- Promote a culture of high performance and continuous improvement that values learning and commitment to quality.
- More than 5 years experience as Claim Manager in insurance or brokerage firms
- Have good relationships with insurance companies
- Excellent in communication, negotiation, and persuasion skills
- Strong adherence to SLA and maintaining clients expectations
- Able to respond to clients inquiry with lightning speed and accuracy
- Strong understanding of insurance terms and conditions and claim appeal process
- Background in medicine is preferred but not a must