- Lead the team to manage and develop technical and servicing strategies on Group Medical and Individual Healthcare claims
- Ensure the service quality of the team on delivering high standard of technical and professional service to internal and external customers
- Implement strategies and utilize digital tools to streamline the claims process and workflows in order to provide extraordinary service and customer journeys to our clients
- Ensure prompt and accurate processing of claims and making sensible claims decision by the team, act as a point of referral on large or complex claims
- Implement robust fraud, waste and abuse detection measures to minimize losses due to fraudulent or abuse claims
- Participate in marketing activities to support new business initiatives from claims perspectives
- Prepare monthly statistical and analytical claims reports in a timely manner
- Prepare large loss advice according to company requirement and assist in monthly claims reports in a timely manner
- Monitor and conduct assessment the performance of service providers
- Build a service competence team by providing sufficient coaching and training to subordinates
- Degree holder, preferably in Healthcare Management or related disciplines
- Over 8 years of experience in medical claims management
- Strong exposure in Group Medical and Individual Medical Insurance
- Solid knowledge in medical terminology and medical claims processes
- Proficient in digital tools and software in claims processing would be an advantage
- Excellent leadership, communication, analytical, problem-solving, decision making and stakeholder management skills
- Customer- centric, self-motivated, detail-minded with strong business acumen and market sense
- Excellent command of written and spoken English and Chinese
