The incumbent will lead the claims team to effectively manage claims from health benefit products to achieve claims KPIs. This includes assess and approve complicated claims, disputed claims, and handle escalated complaints in relation to claims with flexible solutions. Regular Data and Report management with improvement actions, sound quality controls to achieve audit and regulatory requirements. The role is also responsible for delivering exceptional customer experience in claims, meeting the Company’s overall strategic and operational goals.

Critical Tasks and Expected Contributions / Results:

Manage and oversee the local operations of claims and TPA to meet operations, productivity, quality & control and services requirements

Establish proper procedures and policies to be utilized throughout the cycle of claims process

To be responsible for strategic processing and payment / approval of claims

Approve claims within own claims authority and able to make solid recommendation to leadership team for other exceptional claims

Identify areas for procedural improvement to enhance quality of service and operational efficiency

Motivate and develop the claims service team by demonstrating good leadership behaviors and through the use of management best practice, to achieve business goals

Handle enquiries and complaints from customers, distributors, servicing provider, internal staff and media including but not limited to Insurance Authority (IA), Independent Complaint Bureau (ICB), Consumer Council and Health Bureau (HHB)

Prepare management reports, with raw data support, evaluate claims result and trend

Involve in Quality Assurance claims review, identify adjustment and improvement areas, accountable on implement corrective actions.

Prepare for and participate in audits and compliance review and ensure the operations procedure is in compliant to the set rules and regulations

Maintain open communication channel with other departments and management, including but not limited to Underwriting, Finance, Network, Clinical and Business development Team

As a project lead to coordinate with internal and external stakeholders

Experience / Knowledge, Education and Other Requirements:

Diploma or above, preferably with insurance-related qualifications, e.g. FLMI, ICA;

At least 8 years’ experience in Insurance Field, Claims experience is expected, of which at least 4 years in supervisory role;

Knowledge in both Clinical Health & Medical Claims are highly preferable.

Experience in Data Review and Report Summary, with valuable findings and trend observation

Vendor Management Skill is preferable;

Good team player, able to work independently and under pressure;

Possess Customer Centricity Mindset;

Good communication skills, able to explain claim process & decision to various stakeholders.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.