Claims Supervisor

JOB PURPOSE

Manages the efficient delivery of claims management functions to cater to the operational requirements of Micro HMO.

ROLES AND RESPONSIBILITIES

Customer and Provider Experience (Claims)

• Manages the team's consistent and efficient delivery of member availment services and provider billing settlement by meeting Service Level Agreements to ensure positive customer and provider experience.
• Maintains effective communication and good relationship with customers, providers, internal stakeholders, and other parties involved in the member availment and provider billing settlement processes.

Process Management

• Supervises the claims team to deliver their functions according to agreed-upon quality standards and turn -around time such as processing of claims availment from the members; processing of billing from providers and assisting claimants with availment-related concerns.
• Facilitates periodic process reviews with the team and recommends solutions to the Operations Head to address challenges and opportunities for improvement.
• Monitors the team's resolution of all claims-related concerns and makes appropriate actions and decisions, when needed, to ensure that established Service Level Agreements are consistently met.
• Leads the team to comply with customer service standards in all aspects of operations.

Talent Management

• Manages the workforce planning (appropriate structure and jobs), capacity building, and manpower distribution of the team to execute business strategies.
• Performs people management functions (such as, but not limited to, hiring standards, onboarding, performance management, talent development, etc.) to direct reports for productivity, growth, & succession.
• Implements organization culture initiatives in the team consistent with the whole Pioneer Group.

Data Management

• Oversees the collection and storage of required documents and monitors their completeness and validity.
• Implements and monitors the team's compliance to Pioneer's data management standards, policies, and procedures.
• Oversees the delivery of routine and on-demand reports and monitors their compliance with the agreed-upon SLA.

QUALIFICATIONS

• Graduate of bachelor's degree course preferably in business administration, insurance management or any related course.
• With at least 5 years relevant and progressive work experience. Preferably gained in HMO industry specifically in the rural market.
• With experience in start-up company/project is an advantage.
• At least 2 years of progressive management experience in managing contact center specialist working in shifting schedules.
• Proficient in the MS Office (work, excel, PowerPoint)
• Above average English communications skills both oral and written)