Job Status : Closed
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As a Supervisor of Medical Claims, you will lead and oversee the medical claims department, ensuring efficient, accurate, and timely claim processing. You will manage a team of claims specialists, driving performance and adherence to industry regulations while optimizing the claims workflow. Your role will involve analyzing claims data to identify trends, implementing cost-saving measures, and maintaining strong relationships with stakeholders. You will be instrumental in ensuring that policyholders receive exceptional service and that the companyβs claims operations run smoothly and effectively.
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- A minimum of 8 years of experience in underwriting or claims, with at least 2 years in a middle management role in medical underwriting. Prior experience as a medical practitioner is preferred.
- Bachelorβs degree in a related field (Insurance, Business, Healthcare Management, etc.).
- Strong leadership and team management skills.
- Excellent analytical and problem-solving abilities.
- Comprehensive knowledge of medical terminology, insurance regulations, and claims processes.
- Proficiency in claims management software and MS Office Suite.
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- Manage direct billing and reimbursement claims for the group medical portfolio, with a focus on controlling claims costs.
- Oversee the appointed Third-Party Administrator (TPA) for the medical portfolio.
- Coordinate the management of medical claim referrals in collaboration with the appointed TPA.
- Analyze technical results, scheme performance, and membership reports.
- Support product development initiatives, including those for individual medical products, as needed.
