Claims Team Head

BDO Unibank; Mandaluyong; On-site; PHP 600,000 - 1,200,000; Full time

Job summary

BDO Unibank is seeking a Claims Team Head to oversee claims processing and the operational activities of the assigned team. You will ensure efficient processing and equitable settlement of claims in line with policy coverage and conditions, while guiding strategy improvements for client servicing.

In this role, you will supervise Claims Officers and Assistants, monitor adherence to policies, coordinate with insurers/adjusters, and report issues to senior management.

Responsibilities

• Receives settlement offers/LOA and checks if equitably evaluated.
• Reviews insurance policies and conditions of the claim.
• Reviews basis of claim denial and negotiates with insurers/adjusters if necessary, or explains the basis of denial to client/claimant.
• Informs senior management of issues affecting processing or settlement.
• Discusses issues with insurers/adjusters and with clients to reconcile status of claims.
• Conducts claims orientation to clients as required by Marketing Units.
• Updates clients/claimants on the status of the claim.
• Complies with agreed claims procedures and work instructions.

Job description

The Claims Team Head is primarily responsible in overseeing the claims processing and operational activities of the assigned Team. Ensures efficient claims processing of assigned team through equitable settlement of claims filed at the soonest possible time based on insurance policy coverage and conditions. Assists Claims Unit Head in developing strategies for better processes and procedures in relation to claims processing and client servicing. Monitors Claims Officers and/or Claims Assistants and ensures their compliance to company policies and procedures.

The following are the detailed duties and responsibilities of the Claims Team Head:

A. Claims Processing

• 1. Receives settlement offers/ Letter of Authorities (LOA) and check if equitably evaluated.
• 2. Reviews insurance policies and conditions of the claim.
• 3. Reviews basis of claim denial and:
  • i. negotiates/contests with insurers/adjusters if necessary, or
  • ii. explains the basis of denial to client/claimant
• 4. Informs Claims Unit Head or Senior Management of any issues, circumstances or technicality that may affect the processing or settlement of claims being processed.
• 5. Discusses claims issues and concerns with Insurers/ Adjusters.
• 6. Conducts claims orientation to clients as required by Marketing Units.
• 7. Discusses claim issues and concerns to reconcile status of claims with the client.
• 8. Entertains calls/inquiries from clients/claimants, insurers, adjusters, BDO Branches and other concerned parties.
• 9. Joins Insurer/ Adjuster during claims inspections and meetings if necessary to protect the interest of the client.
• 10. Updates clients/ claimants on the status of the claim.
• 11. Complies with the agreed claims procedures and/ or specific work instructions in handling claims.

B. Management of Assigned Team

• 1. Oversees the functions of the Team.
• 2. Checks non-standard letters, reports and other documents prepared by the team.
• 3. Ensures that the work done by the team is within the scope of the following:
  • ii. in accordance to the broking procedures
  • iii. and specific claims policies and procedures of the section

C. Strategy and Team Development

• 1. Oversees the functions of the assigned team.
• 2. Monitors the effectiveness of existing policies and procedures and recommends to Claims Unit Head possible revisions or new strategies for better claims processing and client servicing.
• 3. Coordinates with other Claims Team Heads and Team Leads best practices and provide joint recommendation to Claims Unit Head.
• 4. Ensures continuous development of the team by participating in both in-house and external training.

D. Other Functions

• 1. Prepares documentation other than standard claim letters and reports as required by other units, Claims Unit Head or Senior Management.
• 2. Performs other related functions/tasks as may be assigned from time to time by the Claims Unit Head or Senior Management.