Permanent Role, Singapore
- Reports to the Head of Claims.
- Responsible to lead the team and oversee all operational functions relating to claims to achieve FWD’s standards for high productivity and quality.
- Responsible for providing accurate, reliable and timely monthly reports of claims status.
- Participate in establishing team goals and objectives, monitor team effectiveness and provide direct oversight on issues exceeding the team’s authority.
- Participate in projects and system enhancements and manage all phases of the projects and system enhancements from need-gap analysis to user requirements and testing.
- Responsible for monitoring the quality and quantity of work produced within the team.
- Approve claim payments within authority limits in accordance to contractual terms, stipulated guidelines and regulations. Make recommendations to the Head of Claims/Head of Client Solutions/Claims Committee on claims above the authority limit.
- Review appeals and investigate suspicious claims and recommend appropriate action. Investigate potentially suspicious or wasteful claims using AI technology.
- Capable of resolving escalated calls and problems in consultation with the Head of Claims or Head of Client Solutions.
- Identify and recommend corrective actions to address customer complaints and feedback through changes in the claims process and/or systems.
- Monitor work queues closely to ensure claims are handled timely and accurately within agreed timeline. All pending and suspended claims must be attended to within one month, with proper closure within three months.
- Ensure timely notification to members on claims utilisation to facilitate proper management of benefits and follow-through actions to recover amounts exceeding the limit.
- Prepare and deliver daily/monthly/quarterly management dashboards on claims status, service TAT, payment status, issue tracking, including ad-hoc reports on exceptional claims and other reports on demand.
- Produce timely reports and analysis on staff efficiency and productivity.
- Communicate information to the team and assist with interpretation and implementation of changes.
- Develop operational manuals to clearly document process workflows, internal/regulatory guidelines and audit controls to ensure a consistent understanding of policies and procedures and facilitate consistency in service and quality. Include guidelines for claims adjudication and staff approval limits.
- Conduct regular audit of panel providers to identify possible cases of non-compliance to contractual obligations, overcharging of medication, excessive visits by patients, etc. To analyse trends.
- Conduct regular audit of claims processed by TPAs and team members to evaluate service level and proper adjudication controls.
- Collaborate and build relationships with and maintain mutually beneficial relationships with internal and external customers (such as brokers, TPA, preferred panel providers).
- Work with the team to Identify opportunites to streamline and automate business processes to achieve overall process effectiveness.
- Participate in projects and system enhancements, including need-gap analysis and translation of user requirements to IT specifications to testing and implementation and training of staff.
- Provides input to strategic decisions that affect the functional area of responsibility.
- Represent the unit as an expert or resource to cross-functional project or coordinating teams.
- Perforrm other duties and responsibilities, as assigned.
- Coach and mentor team members. Provide feedback and inculcate the right mindset on ownership and service excellence.
- Responsible for team members scheduling to include work assignments, leave of absence and backup for team members on leave.
- Train team members to handle enquiries promptly, effectively and professionally. This will effectively accelerate response time and reduce complaints.
QUALIFICATIONS / EXPERIENCE
- Degree or Diploma Holder.
- Minimum 8 years of related experience, at least 3 years must be in a managerial capacity.
- Demonstrated ability to manage and lead a team.
- An equivalent combination of education and experience will also be considered.
KNOWLEDGE & TECHNICAL SKILLS
- Good aptitude for working with computers and technology.
- Good knowledge of MS Word and MS Excel.
- Strong aptitude for numbers and calculation.
- Strong attention to details.
- Able to handle multiple tasks.
- Good communication skills – both orally and written.
- Strong focus on customer service and work quality.
- Strong problem solving. Able to find innovative solutions around challenges and obstacles.
- Accepts accountability and follows through in assigned tasks and responsibilities.
- Open to feedback.
- Good delegation and coaching skills.
- Comfortable in managing conflict and tension-filled situations. Firm and objective. View conflict as opportunity to build consensus.