Manager, CI Claims Assessment

We don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us.

We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.

1. Claims Assessment

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  Set goals and objectives for the Critical Illness Claim team to achieve operational results in claim assessment, reporting, and stakeholder engagement.

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  Conduct claims assessment to ensure accurate and fair evaluation of Critical Illness claims.

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  Manage claim decisions within authority level D, ensuring fairness, accuracy, and timeliness.

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  Ensure compliance with claim policies, practices, and procedures across all team activities.

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  Collaborate cross-functionally to resolve complex claim issues and support strategic initiatives.

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  Collaborate Re-insurers to get their experiences for claim process.

2. Quality Assurance

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  Monitor and audit claim handling processes to maintain accuracy and efficiency, including conducting audits, providing feedback to staff, and implementing improvements.

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  Oversee system and procedure enhancements to improve claim processing efficiency.

3. Customer Service

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  Address inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders by providing clear explanations and resolving disputes.

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  Communicate and negotiate effectively with internal and external stakeholders, including customers, medical providers, and legal entities.

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  Represent the Claims Department to share claim experiences with GADs and agents to ensure thorough understanding of claims procedures.

4. Data Analysis and Claims Efficiency

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  Utilize data analytics to monitor performance, identify trends, and support continuous improvement.

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  Analyze claims data to identify trends, patterns, and areas for improvement, helping to optimize claims processes, reduce errors, and detect/prevent fraud, abuse, and waste.

5. Team Management

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  Supervise and develop claim specialists, providing guidance, training, and performance management.

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  Lead a team of claims processors and coordinators, including training, mentoring, and ensuring staff have the necessary resources to perform their roles effectively.

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  Ensure claims are processed accurately, efficiently, and in compliance with regulations, contributing to the financial health and operational success of the organization.

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  Manage stakeholders’ expectations efficiently to balance company benefits and customer experiences.

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  Manage provider relationships to ensure smooth operations between the Health Claims team and providers, especially in direct billing scenarios.

6. Product Development

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  Collaborate with Product and Actuarial teams to contribute claim insights during product development, ensuring clear terms and conditions that enhance customer understanding and minimize claim losses.

• Bachelor’s degree or higher in Law or Medical Doctor

• LOMA certifications: 280, 290, 301, ACS

• Minimum 3 – 5 years in Life Insurance Claims

• At least 3 – 4 years in a managerial role

• Advanced knowledge of Life Insurance and legal frameworks

• Strong analytical and decision-making skills

• Proficiency in claim systems and reporting tools

• Leadership and team development

• Agility and adaptability in a dynamic environment

• Strong communication and negotiation skills

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

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