Claims Executive

The Job:

Provide accurate and efficient adjudication of claims, validation to meet operational and SLA targets

Conduct regular review of current claims processes and working with internal stakeholders on developing new and improved processes to improve efficiency and overall claims experience

Manage escalations and stakeholder relations

Being a champion for change as well as providing on-going training and development for effective claims management.

Liaise with the Insurance Company to verify exceptions as well as to resolve any complaints

Conduct analysis, prepare periodic reports and presentation when required



Requirements:

Strong technical understanding of the claims process for medical claims, preferable in a Third-Party Administrator/Managed Healthcare environment

Highly developed interpersonal skills

Excellent organisational skills and exceptional eye for details

Passionate about driving change to improve business outcomes.

Exceptional communication skills and stakeholder management skills