Manager, CI Claims Assessment

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About the Role

Report to: Senior Manager, Customer Claims
Location: Hochiminh City
Function: Customer & Information Technology | Department: Customer Claims
Type: Managerial

THE OPPORTUNITY:
We are looking for Manager, CI Claims Assessment who is responsible for leading and managing 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