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About the Role

Responsible for determining the validity and authorising settlement of group health insurance claims

Duties:

Pro-actively handle claim cases, including timely investigation into suspicious abuse claims, cost-effectiveness engagement of service providers, regular claims follow up, provide guidance and coaching to subordinates on claims, insurance / risk issues and performance;

Assess, handle and approve all claims types and authorize claims payment within authority and refer claims beyond authority to the Head of Claims / Manager providing sound recommendations;

Draft effective correspondence for complex coverage positions;

Handle claims appeals, complaints, reinsurance / third party recovery claims in the best interest of the Company;

Work with the Head of Claims / Manager to monitor and conduct asse...