Senior Executive, Health Claims

Job Summary

1. To provide preferred claims experience in accordance with the service standard and procedure guideline set.
2. Manage and settle legitimate claims.
3. Provide prompt response to internal and external customers at all times.
4. Participate and complete timely on the Projects assign.
5. Adhere to all claim guidelines and regulations.
6. To guide, check and approve claims assessment done by Junior.

Main Responsibility

Claims Operations

• Registration, processing and adjudication of claims within turnaround time.
• Monitor and follow-up on unsettled claims promptly.
• Handle claims assigned independently or with little supervision and to ensure Company's interests are fully protected by minimizing the claim costs.
• Verify policy liability and alert underwriters on any suspicious, fraudulent claims.
• To escalate grey area cases to medical team
• To guide Junior on daily operation duties.
• To check & approve claims assessment done by Junior.
• To review and advise Junior for complex cases.

Claims Costs

• Investigation on suspicious claims and finalized the claims on a timely basis in accordance with the agreed policies, processes and operational procedures.
• Assess & ensure all the claims process by Third Party Administrator are accurate.
• Manage claims settlement costs and related claims expenses and ensure compliance with internal controls.

Claims Reserving

• Reserves – ensures accuracy of reserve type use and adequacy of reserves for claims handled so that the Company's liabilities are properly reported, and in compliance with Group reserving policies.
• Reviews – ensure that claims assigned are reviewed regularly until closure.

Service Delivery

• Provide good customer claim experience.
• Ensure registration of claims within 2 days from notification
• Issuing acknowledgement/requisition letter within 3 working days
• Assessment within 3 working days from the date of receipt of full documentation and information.
• Payment within 2 working days.
• Issuance of decline letter within 5 working days.
• Reminders letters - every 10 working days.

Customer Service

Response to customers – provide prompt response to internal and external customers at all times.

Projects & Reporting

Participate in projects initiatives to improve efficiency and productivity of the

department/company.

Qualification and Experience Requirement

• Degree in any and/or Diploma in Nursing
• AMII /ACII / DMII or equivalent insurance qualifications
• Minimum of 3 – 5 years' experience in and /or similar role / capacity
• Proficient in English
• Possess good presentation skills
• Possess good negotiation skills
• IT literate
• Mature personality
• Able to work independently and as Teamwork
• Self – motivated
• Team player
• Able to work independently
• Able to handle high volume of work with speed and accuracy

Compliance (this is compulsory section)

Ensure compliance with the requirements of local regulations and all other relevant statutory regulations and guidelines, as well as relevant Company, Regional and Generali policies and procedures.

Information Security (IS):

Responsible for defining requirements as regards to information availability, confidentiality, and integrity. Managers must ensure that all staff members (including temporary staff) and providers comply with the relevant security standards.

Perform risk analysis to determine risk and potential business impacts.

Liaise and co-ordinate with Information System Security Manager on all Information System Security activities within department.

Ensure compliance on Information System Security standards and Information System Security guidelines are adhere to within department.

Data Privacy:

Ensure compliance with Data Privacy laws and regulations, policies, standards, process and procedures implemented by the Company at all times.

Diversity, Equity, Inclusion

Generali is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, gender identity, national origin, veteran or disability status.

At Generali, we believe that it is our differences that make the difference. At the heart of everything we do, we value the fact that we are all human beings, unique in our own ways, bringing different cultures, lifestyles, mindsets, and preferences.

Our commitment is to leverage this Diversity to create long-term value, to be innovative, sustainable, to make the difference for our people, our clients, our partners as well as our communities. We strive to promote a culture where DEI is embedded in how we work and do business every day. All of us around the world are taking actions every day to create an inclusive and accessible workplace, where every person feels empowered to take ownership, to challenge biases and lead the transformation with a human touch.