Assistant Manager, General Insurance Claims

aia; Hong Kong; On-site; HKD 600,000 - 800,000; Full time

Job summary

Blue Cross is seeking a seasoned Claims professional to determine validity and authorize settlement of group health insurance claims in a fast-paced environment.

You will assess diverse claim types, supervise junior staff, liaise across departments, and ensure compliant licensing with Insurance Authority. Proactive fraud investigation, provider management, and process automation are key elements of the role.

Qualifications

• University degree in insurance or related field with 7 years of relevant experience.
• IIQE Papers 1 & 2 must be passed for licensing as an individual insurance agent.
• Candidate should be self-motivated with multitasking ability in a fast-changing environment.
• Proven negotiation, interpersonal and problem-solving skills.
• Intermediate to advanced Excel skills and progress toward ANZIIF/ACII.

Responsibilities

• Pro-actively handle claim cases, including timely investigation into suspicious abuse claims and cost-effective engagement of service providers.
• Assess, handle and approve all claims types and authorize payments within authority; refer complex cases to Head of Claims/Manager.
• Draft effective correspondence for complex coverage positions and handle appeals/ complaints.
• Monitor service providers with Head of Claims/Manager; assist in reports/automation.
• Participate in team meetings, workflow enhancements, UAT, and project work.

Skills

Excel

Negotiation

Interpersonal skills

Problem-solving

Multitasking

Insurance knowledge

Supervisory experience

ANZIIF/ACII progress

Education

University degree in insurance or related

IIQE Paper 1 & 2 passes

Tools

Excel

Job description

About the Role

Responsible for determining the validity and authorising settlement of group health insurance claims

• Pro-actively handle claim cases, including timely investigation into suspicious abuse claims, cost-effectiveness engagement of service providers, regular claims follow up, provide guidance and coaching to subordinates on claims, insurance / risk issues and performance;
• Assess, handle and approve all claims types and authorize claims payment within authority and refer claims beyond authority to the Head of Claims / Manager providing sound recommendations;
• Draft effective correspondence for complex coverage positions;
• Handle claims appeals, complaints, reinsurance / third party recovery claims in the best interest of the Company;
• Work with the Head of Claims / Manager to monitor and conduct assessment of service providers for effective investigation / litigation/ recovery management;
• Assist in reports preparation / automation;
• Actively participate in the team's meeting, enhancement of workflow, claims system, UAT and projects;
• Interface with related departments and relevant parties on projects and joint work to enhance customer service experience;
• Obtain and maintain license as an individual insurance agent of Blue Cross with the Insurance Authority, and, where necessary, upon successful licensing as individual insurance agent with the Insurance Authority, advise on or arrange contracts of insurance or carry on regulated activity.

Education/Work Experience

• University degree with professional insurance or related disciplines plus 7 years' relevant experience; or secondary education or above plus 7 years' relevant experience with at least 3 years at supervisory
• Fulfilment of the fit and proper criteria of the Insurance Authority for licensing as an individual insurance agent of the Company, and the minimum education and qualifications requirements, including but not limited to passes in IIQE Paper 1 & 2 ;
• Self-motivated with the ability to multitask in a fast changing environment;
• Sound negotiation, interpersonal and problem-solving skills;
• Intermediate to advanced Excel skills.
• Progress in achieving ANZIIF or ACII qualification;
• Good knowledge of insurance product, relevant legal procedures and legislations;
• Proven experience in managing complex claims, and advanced insurance knowledge.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

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