The Claims Manager is responsible for the Management of Claims department to ensure the booking and settlement of claims/reinsurance in accordance with the terms of and conditions of the insurance policies and also in compliance with systems and procedures including internal controls of the Company and the applicable laws and regulations.
§ Oversees the payment of claims on the basis of the coverage of the insured customer, the proof of claims and the appraisal of the claim to ensure its authenticity.
§ Set up Key performance indicators (KPI’S) including turn around time (TAT) for the settlement of claims.
§ Ensure the payment of inheritance tax to the authorities on settlement of death claims.
§ Manage functions and personnel per directives, guidelines, established objectives and standard operation procedures.
§ Review and update the departmental systems and procedures to ensure the efficiency and compliance with the current laws, rules and regulations.
§ Ensure Claims decisions are in accordance with policy provisions and established authority limits.
§ Coordinate closely with the company’s lawyer to defend the legal cases arising out of the claim rejected.
§ Coordinate and help the management in setting up the settlement limit for the claims department personnel including for the Manager, Assistant Manager, Supervisor and other claim adjusters.
§ Process functions leading to setting up of the reserve for claims, swift and prompt claim settlement, submission to the reinsurer the portion of the claim reinsured, refer to other departments for change in the policy status and communication with the Management.
§ Ensure that the claims register is maintained as required.
§ Determines need and the level of investigation required for doubtful claims in consultation with management and the appointment of approved outside investigator, if required.
§ Coordinates with other departments and the management on issues requiring their respective involvement.
§ Liaise with other insurance companies and medical/governmental bodies to ensure the correct processing of claims and submission of data.
§ Monitors loss experience of Living/death Benefits and provide suggestions for corrective action in relation to the product pricing for each products/line of business.
§ Ensures accuracy and timely generation of periodical reports for the management.
§ Prepare a list of outstanding claims and reinsurance receivables and rejected claims to agree the total of claims per the list to the General ledger.
§ Controls staff output, their efficiency and effectiveness to cope with existing and growing business. Evaluate performance periodically.
§ Provides training to subordinates and other departmental staff as deemed necessary.
§ Ensure compliance to the local laws and regulations and submission of reporting required by Haymer, Hatmer and other regulatory bodies including that of MASAK.
§ Ensure timely submission of reports to the Management.
§ Participate in the product development process.
§ Participate in the reviewing the policy wordings to ensure the protection of company’s interest relating to claims.
§ Continuation of professional education to keep abreast with the updated laws and regulation including the market practices.
§ Complies with the Code of Conduct, and ensures that it is fully adhered to at all times by all Claims department staff.
§ Carries out any other assignment as required by the Management.
DESIRED SKILLS AND EXPERIENCE
Education and Qualifications
§ 4 years University Graduate in Health, Pharma. MBA degree in business Management will be a plus.
§ Minimum of 10 years of a progressive claims department career path (claims adjuster, examiner and investigator) and minimum of 5 years experience as Claim Manager/Assistant Manager.
§ Good command of English both written and oral.
§ Strong written and verbal communication skills
§ Strong analytical thinking
§ Detail oriented and strong organizational skills
§ Must be familiar with medical procedures, new medical technologies and prescription drugs that are covered under the terms of the policy.
§ Must be familiar with changing legislation and insurance related court decisions that could impact the way that claims are processed.
§ Strong Project management, planning and organizational skills