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About the Role
About the Role
Report to: Head of Claims
Location: AIA Office, Saigon Centre Tower 2, 67 Le Loi street, D.1, HCMC
Function: Customer Office | Department: Claims
Type: Manager
THE OPPORTUNITY:
Lead and manage the Critical Illness Claim team to ensure accurate and timely claim assessment and decision-making within authorized limits, while driving operational excellence through data analytics, system and procedure management, and effective communication with customers and stakeholders.
ROLES AND RESPONSIBILITIES:
1. Claims Assessment
- Set goals and objectives for the Critical Illness Claim team to achieve operational results in claim assessment, reporting, and stakeholder engagement.
- Conduct claims assessment to ensure accurate and fair evaluation of Critical Illness claims.
- Manage claim decisions within authority level D, ensuring fairness, accuracy, and timeliness.
- Ensure compliance with claim policies, practices, and procedures across all team activities.
- Collaborate cross-functionally to resolve complex claim issues and support strategic initiatives.
- Collaborate Re-insurers to get their experiences for claim process.
2. Quality Assurance
- Monitor and audit claim handling processes to maintain accuracy and efficiency, including conducting audits, providing feedback to staff, and implementing improvements.
- Oversee system and procedure enhancements to improve claim processing efficiency.
3. Customer Service
- Address inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders by providing clear explanations and resolving disputes.
- Communicate and negotiate effectively with internal and external stakeholders, including customers, medical providers, and legal entities.
- Represent the Claims Department to share claim experiences with GADs and agents to ensure thorough understanding of claims procedures.
4. Data Analysis and Claims Efficiency
- Utilize data analytics to monitor performance, identify trends, and support continuous improvement.
- Analyze claims data to identify trends, patterns, and areas for improvement, helping to optimize claims processes, reduce errors, and detect/prevent fraud, abuse, and waste.
5. Team Management
- Supervise and develop claim specialists, providing guidance, training, and performance management.
- Lead a team of claims processors and coordinators, including training, mentoring, and ensuring staff have the necessary resources to perform their roles effectively.
- Ensure claims are processed accurately, efficiently, and in compliance with regulations, contributing to the financial health and operational success of the organization.
- Manage stakeholders expectations efficiently to balance company benefits and customer experiences.
- Manage provider relationships to ensure smooth operations between the Health Claims team and providers, especially in direct billing scenarios.
6. Product Development
- Collaborate with Product and Actuarial teams to contribute claim insights during product development, ensuring clear terms and conditions that enhance customer understanding and minimize claim losses.
JOB REQUIREMENTS:
- Bachelor's degree or higher in Law or Medical Doctor
- LOMA certifications: 280, 290, 301, ACS
- Minimum 3 - 5 years in Life Insurance Claims
- At least 3 - 4 years in a managerial role
- Advanced knowledge of Life Insurance and legal frameworks
- Strong analytical and decision-making skills
- Proficiency in claim systems and reporting tools
- Leadership and team development
- Agility and adaptability in a dynamic environment
- Strong communication and negotiation skills
