FIND YOUR BETTER AT AIAIf you believe in better, we'd love to hear from you.WE ARE LOOKING FOR .....Responsible for providing technical medical expertise for claims processing and underwriting decisions plus resolution of customer and/or distributor enquiries. Responsible for managing healthcare related services provided to policy holders/customers.
- Validates and provides inputs on the business cases that will affect the claims procedure including but not limited to adjudication, and as needed, provide inputs to new business and medical underwriting process.
- Refers cases to the different reinsurers for facultative acceptance.
- Confirms validity and approves deposit transfer for any relevant and agreed remediation handling
- Handles referrals of contestable claim cases within the specified underwriting authority by rendering medical opinion.
- Signs off and gives approval to recommended actions regarding claims guidelines and procedures performs relevant quality assurance following quality assurance framework and/or operating guidelines
- Approves the medical claims training programs.
- Reviews and validates budget assumptions based on statistical ratios, trends, past experiences and sales targets ensuring that forecasted budget expenditures are within acceptable limits.
- Acts as resource speaker on Agency/Distribution Forum.
- Provides inputs, reviews, signs-off and endorses the user's specifications to systems enhancement relevant to claims processing and/or medical assessments and other related data analyses/models
MINIMUM JOB REQUIRMENTS- worked in health services and administration
- Proficient in basic MS Office Applications (excel, word & power point) and has ability to learn use of tools/dashboards
- Proficiency in U & I systems, Imaging & Workflow
- With ability to direct, engage, motivate and gain commitment from direct reports when applicable and/or teams
- Negotiation skills
- Analytical skills
- Team player
- Customer service skills
- Satisfactory written and oral communication skills
- Satisfactory interpersonal skills
- Familiar with current legislative & compliance processes affecting life insurance
- With a minimum of five years of functional leadership and technical knowledge of Life, Accident and Health in terms of risk assessment with exposure to new business handling, or reinstatements and claims, and policy changes.
