Claim Senior Officer - Medical Doctor

1. JOB PURPOSE

• Building Claims guidelines and procedures for Health claims to enhance expertise for prompt and accurate assessment and excellent services
• Ensuring claim assessments is 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
• Creating effective training program of medical, underwriting & assessment for claim assessors

2. ACCOUNTABILITIES:

• Delivering prompt, accurate claim assessment and excellent service to Health claims in accordance with Claims Department’s 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 as and when assigned by Line Manager such as building training programs, to be in charge of quality assurance & quality control
• Collaboration and maintaining good relationship 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 insurance field
• Having experience in life insurance underwriting is preferable

Technical skills

• Strong knowledge of claim operations & process
• Emotional intelligence
• Analytical thinking
• Identify and problem-solving
• Negotiation for result 

Soft skills

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

Personal attributes

• Careful
• Proactive
• Enthusiasm
• Integrity

4. CHALLENGES

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