Job Openings Executive, Claim
About the job Executive, Claim
Roles and Responsibilities
- Receive and verify claim documents and enter data into the System, and ensure that proper claim filing procedures is followed
- Ensure quality claim services by responding to customers inquiries and resolving their complaint
- Ensure effective communication with sale team, claimant, and other related parties, such as hospital, doctor, bank partners, local authority, witness, etc. to gather complete information needed to get the optimum claim results with efficient turnaround time
- Examine and assess claim by reviewing insureds insurance policy, medical documentations, credit document, and other additional information collected from outside sources, including claimant, hospital, doctor, bank partners, local authority, insureds employer, other insurance companies, etc.
- Initiating or conducting on-site and off-site investigation of questionable claims
- Confer and consult reinsurers for claim assessment and payment as set out in reinsurance treaty and guideline
- Confer with legal compliance and other related departments, and in some cases outside legal counsel for claim process and litigation
- Ensure that all claim assessment and claim payment are in compliant with policies terms and conditions, Companys policies and procedures as well as applicable law and regulations.
- Verify claim payment amount, prepare claim payment request and ensure timely disbursement of claim payment to claimant
- Draft claim decision documents (acceptance, rejection, and others) and make recommendation with justifiable reasons for Managements decision and approval
- Maintain claim file and record, prepare claim reports and other claim administrative process.
- Review and recommend changes to claims process, guideline, and any related document/form
- Carry out other duties as assigned by the line manager.
- Medical Doctor or Bachelor degree in law or related fields
- Minimum 1 year experience in claim in life or general insurance, and/or underwriting in life insurance
- Knowledgeable in medical terminology and able to analyze and interpret medical history
- Sound judgment, analytical and good problem solving skill, sale and customer service-oriented
- Strong interpersonal skills and ability to manage and work independently and as part of a team with all levels of employees.
- Initiative with a high sense of responsibility
- Attention to detail and ability to multi-task, prioritize, and manage time effectively
- Independent, self-driven, and highly motivated
- High integrity and ability to maintain utmost confidentiality of customers and companys information.
- Good communication in both written and spoken English
- Computer literate