Claims Manager

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 oversee 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.