Claims Consultant

Job Profile Summary:

In this role, you will review, assess and approve major claims within service turnaround time and handle any ad-hoc projects which may be assigned to you. You will report to Team Lead, Claims and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirement and meet service objectives.

Job Description:

• Responsible for High Net Worth claims cases management to deliver optimal service experience.

• Deliver prudent and equitable claims decision within expected service turnaround time.   

• Ensure compliance with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.

• Monitor timely operational workflow management, including suspense and pending rates. 

• Identify gaps and opportunities to enhance customer experience using insights from customer and distributor surveys/feedback. 

• Collaborate closely with underwriters, actuarial and other business units to ensure accurate claims processing and adherence to service level agreements.

• Manage claims investigations by coordinating with loss adjusters, legal advisors, reinsurers, underwriters, medical institutions, claimants, financial consultants to determine claims decision.

• Address claims-related inquiries, service recovery issues, complaints and appeals, assisting in resolving identified problems.  

• Follow up with claimants and medical institutions on outstanding requirements for claims adjudication, providing regular updates through documented processes and effective communication.

• Coach, supervise and guide interns/new hires to deliver accurate and prompt services to customers and financial consultants.

• Conduct technical workshop to our financial consultants in agency or bancassurance channels.

Who we are looking for:

Competencies & Personal Traits

• Team player, mature, meticulous and independent

• Good knowledge of the various types of life claims

• Able to manage deadlines

• Work well with various internal and external stakeholders

Working Experience

• At least 5 - 7 years of experience in assessment of life claims

Professional Qualifications

• LOMA certified or equivalent

Education

• Degree in biology & life sciences discipline