Team Lead

1 week ago

KL Eco Kuala Lumpur, Malaysia Integrated Health Plans Sdn Bhd Full time

Role Overview:

As the Team Leader, you will oversee daily operations and guide a team of claim assessors in processing inpatient and outpatient medical claims, ensuring accuracy, efficiency, and full adherence to policy requirements and regulatory standards.

Key Responsibilities

  • Lead and manage a team of claims assessors responsible for processing inpatient and outpatient medical claims, ensuring accuracy, efficiency, and adherence to policy terms and internal guidelines.
  • Oversee daily operations to ensure timely assessment of claims in line with service level agreements (SLAs) and quality standards.
  • Provide guidance and support to team members on complex claims, escalated issues, and policy interpretations to ensure fair and consistent outcomes.
  • Review and approve high-value or non-standard claims, ensuring appropriate documentation and justification.
  • Monitor team performance through KPIs and quality metrics, addressing gaps through coaching, training, and performance management.
  • Collaborate with cross-functional teams including policy administration and customer service to resolve issues and drive operational improvements.
  • Identify potential fraud, waste, or abuse in claims and coordinate with the appropriate internal teams for further investigation.
  • Support continuous improvement initiatives by analyzing trends, identifying root causes of issues, and recommending process enhancements.
  • Conduct quality audits of claims decisions and documentation to ensure compliance with internal policies and regulatory requirements.
  • Prepare reports and updates for management, providing insights into team performance, claim trends, and operational risks.

Key Requirements:

  • Diploma or higher educational qualification.
  • Strong knowledge of health insurance policies and claims processes.
  • At least 1 years' experience in medical claim management with direct reporting agents.
  • Commitment in driving process improvements and achieving operational excellence.
  • Strong leadership skills with the ability to provide technical guidance and motivate teams to achieve their best performance.
  • Good analytical and problem-solving abilities.
  • Good communication skills, both verbal and written, with the ability to interact with stakeholders at all levels.
  • Versatile and adaptable to fast-changing environments

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