• 10 years exp. in life Insurance
• Exp. in Death and critial illness Claims
• Mature and able to work under pressure

Job Purpose

Assess and approve claim applications, according to the given authority, to deliver the claim approval within the service level agreement. The Senior Claims Assessor is the third level of intermediate assessor positions. The jobholder is responsible to review and consider each claim request for making approval, examine the possibility of loss, preexisting, exclusion condition, and benefit calculation. In some situation, this position is expected to be able to explain the detail of claim assessment to distributors or customers. Please refer to the Claims Competency Matrix and the table of UI and Claims Approval Authority Limit – Claims Authority for approval.

Key Responsibilities:

• Assess and approves with respect to both new and referred claim cases include special request regarding the given authority
• Capture the claim information and benefit payment into the system as required to ensure the accurate payment to the claimant
• Monitor and take action on self pending of claim every 15 days
• Participate into system & process improvement or other assignments from managers to deliver results as expected within the timeline
• Contribute to update the claim assessment guideline
• Update the business continuity plan per assignment
• Engage with the company activities and contributes as a good team player to deliver the highest team performance
• Handle complaints and answer queries from agents, clients and involved parties regarding decision made and service problems.
• Supervise claim payment process and reinsurance (if required) to ensure correctness.
• Explain facts to reach agreement through complexity and compromise.
• Prepare required and useful reports for management information and decision.
• Develop and improve system, procedures and business rules to ensure efficient and effective operations.
• Works closely and coordinates with management for the Fraud Contact Center and the Fraud Investigations team.

Qualifications

• Bachelor degree or higher

• Functional Competency Strong analytical skills, including the ability to detect and report on fraud trends and to identify ways to improve fraud detection, prevention and avoidance.

• Experiences in Life and Critical illness claim is a must
• Good command of English
• Knowledge in Life insurance product, process and regulation, Posses Medical, litigation, or investigation experiences, Negotiation, Training, Initiative and Team work skill, Customer service orientation, Effective problem solving, Reliability and Accountability, Stress tolerance under pressure
• Experience10+ years working experience in life insurance