1. Assist to develop and implement claims policy, guidelines and standards. Regular review the administration procedures to ensure all activities are processed in the most effective means.
2. Support implementation of Health Ecosystem automation
3. Assess and approve claims within own claims authority and make recommendation to senior for those claims exceeding own authority limit, conduct claims investigations where necessary.
4. Assist in overseeing the operations of claims and case management. Resolve day to day claims related issue for all EB products
5. Identify ineffective claims practice. Report and assist in driving initiatives for change
6. Provide assistance in conducting routine audits to assure quality and timely processing targets are maintained and corrective action is taken to avoid recurrence.
61 5 years or more solid working experience in claims adjudication and medical services pre-approval in life or medical insurance
61 Knowledge on Employee benefits products (e.g. group life) and back office operations
61 Proven and progressive experience preferably incorporting business operations management principles (including service quality, business control and continuous improvement activities etc.)
61 Excellent understanding of quality assurance, control, metrics and continuous improvement
61 Strong analytical skills to understand to translate, simplify and proritize the requirement as well as root cause analysis for remedial actions / preventive measures.
61 Strong communication and interpersonal skills required, including the ability to form effective relationships and achieve influence at the most senior level in the organisation.
61 Understand and interpret complex business and Hong Kong Insurance requirements (including regulatory requirements)
61 Ability to work within an environment of different cultures.