Claim Officer (Medical Doctor)

1.JOB PURPOSE

• Ensuring claim assessments accurate and in strict compliance with the terms and conditions of the contract, while also considering equitable and reasonable factors within the permitted limits to satisfy the customer.
• Building claims guidelines and procedures for health claims to enhance expertise for prompt and accurate assessment and excellent services.
• Creating effective training programs for medical, underwriting & assessment for claim assessors; for training/ coaching to upgrade claims assessors capacity.
• In charge of quality control & quality assurance duties.

2. ACCOUNTABILITIES

• Delivering prompt, accurate claim assessments and excellent service to health claims in accordance with Claims Departments guidelines and procedures.
• Approving health claims as per prescribed authority limits; resolving complex claims and/or developing recommended solutions based on good judgment, initiative and technical skills.
• Supporting department targets and company objectives and assigned tasks by line manager such as building training programs and overseeing quality assurance & quality control.
• Collaborating and maintaining good relationships with cross departments/ functions to smoothly solve all claims-related issues and reach claims objectives.

3. REQUIREMENTS

Education and Experience

• Medical doctor or equivalent, preferably in insurance field.
• Preferably 23 years of experience in life insurance; claims handling is preferable.

Technical skills

• Strong knowledge of claim operations & processes.
• Emotional intelligence.
• Analytical thinking.
• Identifying and problem-solving.
• Negotiation for results.

Soft skills

• Proficiency in Microsoft Office (Work, Excel...).
• Teamwork
• Effective time management
• Collaborative

Personal attributes

• Careful
• Proactive
• Enthusiastic
• Integrity

4. CHALLENGES

• Ensure that all claims are handled promptly and effectively with agreed service standards.
• To ensure re-underwriting and claim assessments are accurate, and to be flexible in decisions to satisfy customers within allowable limits.
• Work under high pressure.