Health Insurance Claim Head

About the role

Lead the Employee Benefit Insurance After Sale team including Data and Claim team Responsibilities of After Sale team include processing claims, assist clients with endorsements, documents and data keeping Oversees insurance claims that are in progress to make sure claim decision come out according to SLA and claim appraisal result is justified according to the agreed TC Assist clients who are admitted to hospital by coordinating with insurance and hospitals when necessary Make daily, weekly, and monthly report for claim updates Customer care helpline - 24 hours Develop and maintain relationships with insurance companies' claim departments Negotiate and appeal rejected claims with insurance Monitor endorsement process and make sure SLA is achieved Check and make sure member cards are correct and send them to the clients on time Assist with client closing process by coordinating with insurance and making sure the policy T and C is as per agreed Put in place control mechanisms that enable achievement of high levels of customer satisfaction. Ensure quality and service excellence to clients and 5/5 client satisfaction Continuously improve current systems and processes Promote a culture of high performance and continuous improvement that values learning and commitment to quality. More than 5 years experience as Claim Manager in insurance or brokerage firms Have good relationships with insurance companies Excellent in communication, negotiation, and persuasion skills Strong adherence to SLA and maintaining clients expectations Able to respond to clients inquiry with lightning speed and accuracy Strong understanding of insurance terms and conditions and claim appeal process Background in medicine is preferred but not a must

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