Senior Claims Officer

2 months ago

Hong Kong, Central and Western District, Hong Kong SAR China Zurich Insurance Company Full time

Job Summary

The Senior Claims Officer (Medical) is responsible for maintaining the smooth daily operation of the claims section, ensuring timely and accurate settlement of claims, and providing excellent customer service.

Key Responsibilities

  • Manage the claims operational flow, including claims turnaround time, hotline service, and quality of outgoing claims correspondence.
  • Conduct claims assessments in compliance with authority levels and ensure claims procedures are in line with company rules.
  • Support the claims function in prompt and accurate settlement of claims and negotiation with different parties.
  • Ensure claims procedure compliance and successful implementation of procedures to avoid claims abuse.

Job Accountabilities

The Senior Claims Officer (Medical) is accountable for:

  • Meeting claim service standards and turnaround times.
  • Approving claims cases within own authority limits and making recommendations to senior for those exceeding own authority limits.
  • Handling enquiries and complaints from customers, sales force, other insurance regulatory bodies, and internal staff.
  • Providing administration support in claims area, including composing claims correspondences, setting up, reviewing, and revising claims procedures or guidelines or workflows and claims forms.
  • Analyzing, providing advice, and handling strategy for complaint/appeal claim cases independently.
  • Assisting in preparing management reports, statistical, and analytical claims reports in a timely manner for regular claims statistics and irregular claims trends.
  • Providing proactive suggestions to enhance the quality of work.
  • Participating in departmental/company projects as necessary.
  • Assisting in ad-hoc projects, system enhancements, or tasks assigned by the superior.
  • Backing up teammate's work if necessary due to insufficient manpower of the team.

Job Qualifications

The ideal candidate should possess:

  • A degree/diploma holder or high school graduate with relevant claims work experience.
  • Professional qualification in Life Insurance, including FLMI (Fellow, Life Management Institute), is preferable.
  • Over 2 years of experience in Medical Insurance claims handling.
  • Knowledge of Medical insurance products, claims procedure, and operations.
  • Experience in handling claims-related projects is highly preferred.
  • Basic medical skill is preferable.
  • Strong customer-oriented mindset & skills.
  • Good communication and interpersonal skills.
  • Complaint handling skills and ability to deal with difficult people and mature to handle awful situations.
  • Proficient in MS Word, Excel, and Chinese word processing.
  • Good command of both spoken and written English and Chinese.
  • Candidates with different levels of relevant experience will be considered for different positions.

Why Zurich

Zurich Insurance Company is an equal opportunity employer that values diversity and inclusivity. We take an optimistic approach by focusing on the positives and constantly asking What can go right?

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