Manager - Medical Claims
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Key skills for this role
About the Role
Are you passionate about making a meaningful impact in healthcare insurance space? At Great Eastern, we’re redefining what it means to be a claim professional.
Key Skills for This Role
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Overview
Are you passionate about making a meaningful impact in healthcare insurance space?
At Great Eastern, we’re redefining what it means to be a claim professional.
Join a passionate team where your medical knowledge, analytical skills, and attention to detail will directly impact the lives of our customers and the future of health insurance.
You’ll play a vital role in ensuring our policyholders receive timely and accurate support when they need it most.
You’ll also be empowered to contribute to service excellence initiatives that enhance the overall claims experience.
It’s a career path that builds deep expertise in claims assessment and customer care.
• Claims Assessment & Decision Making
- Assess integrated shield claims and appeals accurately and within established service standards to ensure timely and correct claim payments.
- Manage claim investigations and appeals, including reviewing medical documentation and policy terms.
- Conduct review of pending claim to ensure reserve adequacy and closure of claims in a timely manner.
- Identify claim patterns and unusual or inappropriate practices and recommend improvements to strengthen claims controls and streamline claim processes.
• Stakeholder & Customer Engagement
- Collaborate with medical institutions, policyholders, and internal stakeholders to gather and clarify clinical information or outstanding requirements.
- Deliver high standards of customer service and strengthen relationships with customers and distribution channels.
• Drive Service Excellence & Process Improvement
- Deliver accurate and timely assessment of medical claims, ensuring fair payouts in line with our service standards and adherence to policy terms.
- Provide clear, empathetic communication timely to policyholders, medical professionals, and internal stakeholders, making the claims process smooth and transparent.
- Participate in claims process reviews, system enhancements, and service excellence initiatives to improve efficiency, controls, and customer experience.
- Ensure Compliance
- Adhere to internal policies and external regulatory requirements to maintain integrity and trust in our claims operations.
- Take accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks.
- Maintain awareness of industry trends on regulatory compliance, emerging threats and appropriate steps to mitigate the risks.
- Highlight any potential concerns/risks and proactively shares best risk management practices.
- Bachelor’s degree or Professional Insurance Certificate or a related insurance or healthcare discipline
- At least 5 years of experience in relevant claims processing experience
- Strong grasp of medical practices, terminology, ICD/CPT codes, and insurance policy terms
- Strong analytical skills with ability to interpret complex medical data, spot trends, and make sound decisions under pressure
- Detail-oriented with a proven track record of managing high processing volumes without compromising quality
- Customer-focused and excellent at building relationships with stakeholders and delivering clear, empathetic communication
- Team players; are eager to learn and grow in a fast-paced, collaborative environment that values innovation and service excellence.
How You Succeed
- Champion and embody our Core Values in everyday tasks and interactions.
- Demonstrate high level of integrity and accountability.
- Take initiative to drive improvements and embrace change.
- Take accountability of business and regulatory compliance risks, implementing measures to mitigate them effectively.
- Keep abreast with industry trends, regulatory compliance, and emerging threats and technologies to understand and highlight potential concerns/ risks to safeguard our company proactively.
Who We Are
Founded in 1908, Great Eastern is a well-established market leader and trusted brand in Singapore and Malaysia.
With over S$100 billion in assets and more than 16 million policyholders, including 12.5 million from government schemes, it provides insurance solutions to customers through three successful distribution channels – a tied agency force, bancassurance, and financial advisory firm Great Eastern Financial Advisers.
The Group also operates in Indonesia and Brunei.
The Great Eastern Life Assurance Company Limited and Great Eastern General Insurance Limited have been assigned the financial strength and counterparty credit ratings of "AA-" by S&P Global Ratings since 2010, one of the highest among Asian life insurance companies.
Great Eastern's asset management subsidiary, Lion Global Investors Limited, is one of the leading asset management companies in Southeast Asia.
Great Eastern is a subsidiary of OCBC, the longest established Singapore bank, formed in 1932.
It is the second largest financial services group in Southeast Asia by assets and one of the world’s most highly-rated banks, with an Aa1 rating from Moody’s and AA- by both Fitch and S&P.
Recognised for its financial strength and stability, OCBC is consistently ranked among the World’s Top 50 Safest Banks by Global Finance and has been named Best Managed Bank in Singapore by The Asian Banker.
To All Recruitment Agencies
Great Eastern does not accept unsolicited agency resumes.
Please do not forward resumes to our email or our employees.
We will not be responsible for any fees related to unsolicited resumes.
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