Head of Claim Services (Thai Nationality Only)MBK Life Assurance PCL.

Degree

Five-day work week
Performance bonus
Medical insurance
Dental insurance
Life insurance

Job Responsibilities: 
Accountable for the proper administration of the claims processing functions. Develop a strong understanding of claim modules including claims workflow. Establish performance standards, goals, and priorities and monitor performance in those areas, and ensure compliance with law and regulations.
Responsible for accurate claim processing and payment. Ensure the claims are processed in accordance with reimbursement guidelines. Develop and implement processes that ensure accurate claim processing. Establish process for auditing claims processing to ensure monitor for a high level of accuracy.
Responsible for continuous improvement within the claims department and working with other departments to improve efficiency and productivity.
Manage data analysis and reporting metrics by utilizing reporting applications to produce ad hoc reports, design and create metrics.
Manage vendor relationship. Responsible for managing all vendors used to support claims processing and auditing, including reviewing and modifying contracts, establishing and managing performance expectations, resolving issues, aligning goals and strategy, fostering good corporation and following-up on issue resolution and periodically surveying market for alternative vendors.
Work closely with in-house legal counsel and Medical counsel when necessary
Draft reporting narrative and coordinate with company internal auditor to ensure the Claims department is in compliance.
Function as key liaison between Claims and TPA on data intake to ensure quality, timeliness and accuracy of TPA data received.
Analyze and control expenditures of the department to conform to budgetary requirements as they are periodically communicated.
Working within the framework of the Company's HR policies: Appraise performance; Reward and discipline employees; Address complaints and resolve problems.
Create, implement and maintain a Claims training program for all Claims staff.
Project work as assigned
Qualifications:
Bachelors' degree preferred in Nursing with 5 or more years of equivalent work experience in a Claims service of insurance industry.
Strong organizational skills and detail oriented.
Ability to work independently and handle multiple tasks simultaneously.
Excellent verbal and written communication skills.
Excellent customer service and collaboration skills.
Extensive knowledge of insurance contracts and adjusting techniques.
Familiarity with medical terminology, legal procedures and claim evaluation.
Demonstrated leadership, coaching, influencing, and teamwork skills.
Computer literacy, including working knowledge of MS Office i.e. WORD, Excel, PowerPoint.
Good command of English