Individual Insurance Fax Claim

Job Purpose:

• Oversee, manage, and develop personnel and workforce planning to execute Fax Claim tasks in line with company policies and contractual agreements.
• Approve health and accident claims, participate in relevant Health Care projects, and contribute to various company initiatives.

Key Responsibilities:

• Approve health and accident claims and payments for direct billing with partner hospitals as per contracts and policies.
• Manage TPA claims for other companies using Fax Claim service.
• Support complex claim evaluations and provide medical insights to team members.
• Maintain KPIs and evaluate staff performance.
• Align department plans with division objectives.
• Manage annual budget planning and cost control.
• Supervise, track, and evaluate department operations to ensure goal alignment.
• Manage workforce allocation to meet departmental targets.
• Communicate necessary information to enhance team understanding and collaboration.
• Mentor and coach team members for skills improvement and adaptation to technological and regulatory changes.
• Stay updated on technological advancements and new knowledge relevant to departmental work.
• Develop and maintain work standards and procedures.
• Execute additional projects as assigned by superiors.

Qualifications:

• Master or Bachelor's degree in Medical or Health Sciences.
• Additional knowledge in life insurance (e.g., FLMA certification) is advantageous.
• 3 - 5 years experience in claims processing and 5 years in management level.
• Proficiency in health insurance claims.
• Leadership abilities to motivate and guide team performance.
• Strong analytical, planning, supervisory, and communication skills.
• Proficient in English and computer applications.