Claims Manager

MediCard Phils., Inc.; Philippines; On-site; PHP 600,000 - 900,000; Full time

Job summary

MediCard Phils., Inc. is seeking a senior claims team leader to oversee performance management, risk controls, and process improvements within the claims group.

You will lead a team, ensure timely processing of claims, monitor SLAs, coach staff, and coordinate with internal partners to sustain high-quality service and compliance. Strong English and Filipino communication, data-driven decision making, and proficiency in MS Office are essential.

Qualifications

• Requires strong analytical and detail-oriented mindset.
• Proficient in MS Office applications for reporting and daily tasks.
• Excellent written and oral communication in English and Filipino.
• Experience in managing a claims team and achieving targets.

Responsibilities

• Oversee performance management of the claims team and ensure timely processing of transactions.
• Cognizant of data governance, privacy, and regulatory requirements in claims processing.
• Lead planning and supervision of team workload to ensure adequate support for claims volume.
• Escalate and resolve complex operational and customer issues within authority limits.

Skills

Analytical skills

MS Office proficiency

Bilingual English/Filipino

Leadership

Education

College degree

Tools

MS Office

Job description

Roles and Responsibilities:

Performance management

• Ensure that claims are processed in a timely and judicious manner; with clear, concise, and customer-friendly communications.

• Cognizant of data governance, data privacy and relevant regulations in ensuring continuous, timely and effective processing of claims transactions.

• Plans, schedules, supervises and controls work operations within the team to ensure that the claims volume can be adequately supported.

• Reviews and decides on cases referred by claim assessors within authority limit in accordance with proper claims practices.

• Closely monitor TATs and SLAs, identify process bottlenecks and recommend improvements accordingly.

• Act as the primary escalation and decision-making point for complex operational and customer issues. This includes resolution of customer complaints, offer viable courses of action and/or recommend handling of exceptional cases beyond own authority for management approval.

• Reviews, edits, approves and/or signs letters, memos and documents and other correspondence to the policy owner, agent or other concerned parties pertaining to processing of Claims transactions.

Leadership responsibilities

• Conduct regular conversations with team members to provide feedback on performance, discuss strengths and areas for improvement, and address concerns.

• Evaluates job performance of employees for probationary and/or regular appointments and for performance management purposes.

• Conduct learning sessions to upskill team members.

• Define and discuss performance goals for each team member.

• Drive action plans to improve team engagement.

• Assist the Head of Claims in developing and implementing action plans in accordance with set priorities.

• Build strong relationships with Distribution, Agency, Customer Service, Compliance, Finance, Technology, Operations, Marketing, and other business units.

• Assist and provide insights for cross functional and management reporting.

• Performs other responsibilities and duties periodically assigned by superior o meet operational and/or other requirements.

Risk management

• Participates in analysis and recommendations of cases referred to the Executive in charge for decision on requests for reconsideration and exception cases.

• Review claims processes to identify risk areas and recommend improvements

• Perform and overhaul adherence to control standards as defined in the control framework (including but not limited to eGRC, FSCA, ICFR/non-ICFR controls, AML requirements, and operational risk management).

• Monitor suspense accounts, unresolved transactions, operational exceptions, and control deficiencies.

• Own and maintain policies, procedures, operating guidelines, and process documentation.

Projects and initiatives

• Develop and implement initiatives that improve team efficiency, productivity, customer experience, and operational performance.

• Oversee change management activities and support successful implementation and adoption of new processes, systems, and business solutions.

• Provides process owner expertise to various initiatives of the Company through attendance to requested meetings, email and phone consultations and the like.

• Participate in and support automation initiatives by providing inputs, defining requirements and testing enhancements.

Minimum Job Requirement

• College graduate of any course

• With at least five (5) years’ experience in managing the claims team and with a strong track record in achieving company targets

• Strong analytical skills with high attention to detail and accuracy

• Proficient in the use of MS Office applications and other business application systems for reporting and daily transaction handling

• With excellent written and oral communication skills in both English and Filipino.