Head of Family Claims - Kuala Lumpur
job description
The Company
Our client is a prominent Insurance company .Currently seeking a skilled and strong Head of Credit Controller to lead a team of professionals and to also deal with their international clients.
The Role
The Head Of Family Claims reports to the Vice President , encompassing the below skillset .
Head Of Claims
– To ensure All Family claims assessments, processing, compensation and approval are justified and done to guidelines and standards set.
– To monitor and liaise with MCO to ensure admission and discharge process are done as per standards agreed
– Produce and analyze reports on claims experience and provide appropriate recommendation in claims cost containment to the management
– To be responsible for matters related to the following committees:
1) Management Committee (member)
2) Family Claims Committee (member)
Essential Functions
- Manage and provide direction and leadership to all subordinates in Family Claims and Medical Services Department
- Monitor and recommend strategies and ideas to improve the department
- Monitor processes and procedures to ensure utilization of best practices and optimum efficiencies in managing claims to ensure reduction in claims processing time; minimize unnecessary investigations and efficient detection of fraudulent claims
- Monitor the performance of MCO as per agreement in the SSA and to liaise MCO to facilitate admission and discharge process of medical claims.
- To do analysis of claims pattern to identify- claims risk which can be used as a guide by underwriting and marketing – inappropriate charges by health care providers whom can be blacklisted or removed from panel ship
- Operation and Management
- Supervise, coordinate and monitor the quality assurance of Claims in:
- Registration,
- Processing
- Approval and Settlement (including appeal)
- Reporting
- Monitor and implement information integration and industry practice changes
- Monitor and ensure that all deadlines for the claims are followed and met strictly
- Develop guidelines and procedures for the department for continuous efficiency
- Maintain the claims approval up to the different levels of authority limits are being adhered to.
- Prepare and monitor a timely reporting to regulatory authorities, nominated third parties, agency members, relevant departments and management
- Provide prompt response to/from Retakaful Operators/ Reinsurance, BNM, MTA, ISM, MCO, marketing and branch personnel, agency members and applicants/ certificate holders
- Provide prompt response to all complaints by BNM, FMB, agency members, certificate holders and concerned parties. Work closely with complaints unit and relevant department if requires so
- Attend and/ or arrange meetings with relevant parties, Internal or External Committees
- Recommend and monitor appointment of panel hospitals and clinics
- Supervising the performance of subordinates
- Assist Head of Family Technical in all matters related to Family Claims
- Technical Support
- Provide, Coordinate and monitor claims and technical support. Assist Head of Technical in conducting the claims training to agency members, marketing and branch personnel and fellow staff
- Compliance
- Coordinate and monitor requirements of the Takaful Act 1984, Bank Negara Guidelines, MTA Guidelines, Internal and External Service Level/ Benchmark, Bank Negara Audit and External Audit are complied with.
Skills & Experience
- Education:- Degree
- Experience: 10 years in Takaful Family Claims/ Life Insurance Claims
- KSA’s : Adequate Claims knowledge and ability to head the Family Claims & Medical Services Dept
- Knowledge of applicable law and regulation governing the Takaful operation and Family product plans.
- Ability to manage a team of staff to meet the standards sets by management
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