Personal Accident & Travel Claims Supervisor

American International Group; Ciudad de México; Presencial; MXN 300,000 - 600,000; Jornada completa

Descripción de la vacante

Una firma innovadora busca un Supervisor de Reclamos de Accidentes Personales y Viajes, responsable de la autorización médica y la gestión de reclamos complejos. En este rol, tendrás la oportunidad de liderar la supervisión de casos médicos, asegurando la mejor atención a los asegurados. Este puesto ofrece un entorno dinámico donde se valora la comunicación efectiva y la resolución de conflictos. Si tienes pasión por ayudar a otros y deseas marcar la diferencia en el sector de seguros, esta es tu oportunidad para crecer profesionalmente y contribuir a un equipo comprometido con la excelencia.

Formación

• Experiencia mínima de 3 años en manejo de reclamos médicos o de accidentes personales.
• Conocimiento en interpretación de pólizas y resolución de reclamos.

Responsabilidades

• Supervisar y emitir asesoría médica sobre reclamos de accidentes personales y cobertura de enfermedades graves.
• Gestionar la atención a solicitudes de reclamos de partes aseguradas y unidades médicas.

Conocimientos

Manejo de reclamos

Comunicación efectiva

Resolución de conflictos

Conocimiento médico

Gestión del tiempo

Análisis detallado

Educación

Licenciatura en Medicina

Descripción del empleo

Personal Accident & Travel Claims Supervisor

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Locations: Mexico City

Time Type: Full time

Posted on: Posted 30+ Days Ago

Job Requisition ID: JR2406100

Who we are

American International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and services that help businesses and individuals protect their assets and manage risks.

We’re also committed to making a positive difference for our colleagues and in the communities where we work and live. We encourage colleagues to give back to the causes they care most about, supporting these efforts through our Volunteer Time Off and Matching Grants Programs.

About the role

What you need to know:

Medical examiner and supervisor of personal accident and serious illness claims, responsible for medical and surgical authorizations, as well as supervision of the operational management of business lines with technical opinion, with participation and medical opinion in reconsiderations of health claims and medical auditor in medical care based on injury diagnosis.

Your contribution at AIG

The employee will be in charge of supervising and issuing medical advice on personal accident and health coverage for Serious Illness coverage with an approximate claims volume of 200 cases.

Duties and Responsibilities

1. Functional Responsibilities:
2. Provide follow-up and solutions to claims requests received from insured parties and medical units regarding medical and surgical care for accidents, as well as attention to claims for compensation for serious illnesses.
3. Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate for high value complex claims such as cancer, muscular dystrophy, sclerosis, heart attacks, strokes, as well as highly specialized surgeries based on the organization's best practices.
4. Ensure effective management of healthcare providers and litigation within a personal mission, including demonstrable savings such as management of important medical trends.
5. Reporting key claims messages to their Team Manager and to internal stakeholders.
6. Broader internal / external stakeholder communication where required, as (LoB) technical claims expert and thought leader.
7. Delivery of technical training to colleagues and external contacts as appropriate.
8. Assist in continuous improvement across the region through support for the Quality Assurance / Regional Audit processes.
9. Ensure adherence to best practice procedures for (LoB) Complex claims, consistent with global best practice.
10. Handle higher level of complexity claims Complex losses within authority limits.

1. Accountabilities:
2. Key contact for resolving claims requests received from insured persons and medical units relating to medical and surgical care for accidents, as well as handling claims for compensation for serious illnesses.
3. Timely, accurate and customer focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expense.
4. Effective communication and management of key advanced Complex claims and (LoB) portfolio messages to internal stakeholders and customers/clients.
5. Financial control through consistent reserve and other financial transaction discipline.
6. Accurate and consistent policy interpretation.
7. Medical audits of our provider network.

1. Leadership Skills:
2. Professional with a high sense of urgency, conflict resolution, empathy and high communication skills.
3. Excellent communication skills, both written & verbal.
4. Good presentation skills and medical file knowledge.
5. Time management – ability to manage & prioritize workload and diary management.
6. Ability to contribute effectively within a team environment and with internal/external stakeholders at all levels.
7. Ability to assist with technical medical training to team claim handlers as required.
8. Ability to influence claims and non-claims stakeholders to effectively direct claims strategy.

1. Technical Skills and Expertise:
2. Knowledge of general medicine.
3. Knowledge in the preparation and reading of medical reports and interpretations.
4. Expert in identifying injuries and/or degenerative diseases.
5. Experience and knowledge in personal accident and health claims.
6. Policy language skills enabling accurate and consistent policy wording interpretation.
7. A advanced and thorough knowledge of legal / regulatory and litigation / procedural requirements for their line of business.
8. Experience in negotiation, mediation and arbitration, on complex claims.
9. Experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement.

What we’re looking for:

• Experience:
• Bachelor of Medicine.
• At least 3 years of claims handling or case management for medical or personal accident claims portfolio.
• At least 2 years of handling and managing medical service providers networks, cost containment strategies and continuous improvement strategies.
• Medium to advanced policy wording interpretation and claims resolution on personal accident or medical expenses policies.
• People management experience is not required but is a plus.
• Proven experience in the handling of complex case management (e.g. cancer, muscular dystrophy, sclerosis, heart attacks, strokes, as well as highly specialized etc.).
• Along with technical skills required for the job, soft skills like effective broker engagement, teamwork, proactive claims management, effective time management/prioritization, calendar organization.
• Effective analytical and attention to detail.

Ready to accelerate your career? We would love to hear from you.

Reimagining insurance to make a bigger difference to the world

American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world’s most far-reaching property casualty networks. It is an exciting time to join us — across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.

Welcome to a culture of belonging

We’re committed to creating a culture that truly respects and celebrates each other’s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through our flexible work arrangements, diversity and inclusion learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The diversity of our people is one of AIG’s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.

AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.

AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to [e-mail].

Functional Area:

CL - Claims

AIG SEGUROS MEXICO S.A. DE C.V.