Senior Health Claims Operations Leader

Key Objective

The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.

Key Accountabilities & Responsibilities

• Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis.
• Auditing cashless claims for Group and Individual hospitalisation and surgical claims.
• Overseeing and facilitating payment processing for bordereaux medical claims.
• Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements.
• To monitor the performance of the appointed TPA and be proactive on liaising with TPA on resolving issues.
• Keeping constant communication with managemen...