Claim Manager (Health Insurance)
Claim Manager (Health Insurance)
fullerton health vietnam5-7 Years
- Posted 9 hours ago
- Be among the first 10 applicants
Job Description
Key Responsibilities
- Manage the daily operations of the assigned Claims team and ensure delivery of SLA/TAT, productivity, quality, and backlog targets.
- Organize, review, and approve within delegated authority outpatient, inpatient, accident, maternity, dental, salary compensation, death following all causes, and total or partial disablement following all causes claims; resolve complex or escalated cases.
- Monitor resource allocation and quality and ensure compliance with benefits, policy terms, procedures, and Claims standards.
- Manage performance and support coaching, training, recruitment, and capability development of team members.
- Resolve operational issues and coordinate with insurers, brokers, healthcare providers, clients, and internal functions.
- Prepare and analyze reports; support governance meetings, audits, and process, system, and AI/OCR improvements.
- Perform other duties assigned by the Company.
- Bachelor's degree in Insurance, Economics, Finance, Business Administration, Medicine/Pharmacy, or a related field.
- At least 5 years of relevant healthcare claims/TPA/insurance experience, including at least 2 years in a supervisory or management role.
- Strong knowledge of FHVI-managed claim types, investigation, loss assessment, reserving, legal and regulatory matters, litigation, and fraud awareness.
- Demonstrated ability in team leadership, coaching, capacity allocation, and performance control in a high-volume environment.
- Good analytical, decision-making, problem-solving, communication, organization, and stakeholder-management skills.
- Working English for reading/writing emails and reports and attending routine meetings; good command of Excel and claims systems.
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