JOB DESCRIPTION

CLAIMS SPECIALIST (LIFE & HEALTH CLAIMS/OPERATIONS)

The Life and Health Operations (LHO) department plays a pivotal role in ensuring we provide our customers with affordable and comprehensive life and health products, with efficient processes to allow optimal service to our customers.

As an Assistant Manager/Manager of the Claim Operation Specialist unit, you will be responsible for managing projects and providing central claims support which include life and health product reviews, system support, governance, peer reviews, and continuous improvement to claim operations. You will be attached to the Claim Operation Specialist Unit and report to the Section Lead. You will work closely with the claim processing team to ensure operational targets are met and will have chance to cross trained on other claim types where possible.

Other key responsibilities include:

Product Review (Medical and Life Plans)

• Perform Review of Contract and Product Specification, including providing requirements for system changes, coordinating/solicit teams inputs, workgroup discussions on medical and life claims.
• Be part of the product implementation workgroup and have opportunity work with various internal and/or external parties

System Support

• Serves as a Claim Subject Matter Expert, as a liaison and reference point between Claim Business and the Business Analyst (BA)/Technical analyst, ensuring that the business requirement are translated to functional requirements
• Conduct prioritization with BA and IT on system enhancements
• Support all production issues, rectifications, data patches/configuration changes or tasks that requires some testing etc.
• Involved in ongoing requirement gatherings
• Review impact/process changes due to system changes
• UREQ/BSD review from claim business user perspective
• Engagement, communication & briefing to stakeholders on impact areas in relation to system/product/benefit changes

Governance

• Management of work instructions and documentation control
• Ensure governance and due diligence over claim processes and services engaged by Claims Section
• Perform claim peer review inspection
• Review and suggest process improvements for developing or implementing best practices. Lead and participate in operation efficiency projects to bring efficiency to claims processes
• Support the Claims team in any compliance reporting, monitoring/reporting of exceptions, claim financial tracking, planning, and strategizing of claims management and other related duties
• Work closely and maintain good rapport with representatives (financial consultants, advisers, brokers, etc.), officers and staff of other departments to carry out his/her work effectively
• Communicate effectively with reinsurers, auditors and external stakeholders such as the CPF Board, and hospitals, clinics, nursing homes in the course of claims administration or audits
• Conduct Claims Workshops to financial advisors when the need arises
• Undertake any projects or duties, including administrative duties, as assigned by Section Manager or Head of Function.

Requirements

• Qualifications - External • Diploma/Degree holder with five or more years of experience in Claims
• Strong background in Life & Integrated Shield claim processes
• Strong policy language skills enabling accurate and consistent policy wording interpretation
• Strong critical thinking skills and ability to handle complex computation
• Strong written and communication skills, committed team player
• Ability to work under pressure and manage deadlines
• Meticulous with good analytical, organisational skills
• Able to multi-task and work independently
• Customer centric