About FWD Group

FWD Group is a pan-Asian life insurance business with more than 13 million customers across 10 markets, including some of the fastest-growing insurance markets in the world. The company was established in 2013 and is focused on changing the way people feel about insurance. FWD’s customer-led and digitally enabled approach aims to deliver innovative propositions, easy-to-understand products and a simpler insurance experience.

Job Purpose:

• Leading the health claim reimbursement team to provide the excellent service to ensure the best customer experience always being delivered.
• In charge of end-to-end claim process from reception of request to examination and payment delivery, include reconsideration of nonpayment. Including handling the denial and appeal case effectively and reducing disputes.

Key Responsibilities:

• Achievement of claim service within SLA
• Conduct and monitors work schedule of claim assessor to actively manage if unplanned event happened.
• Examines and review the complex cases escalated from team.
• Provide resolution and consultation to team, distributor, customers, group client HR, and brokers.
• Encourage and organizes team member to process requests within timely manner and accurately.
• Manage and respond to denial and appeals case within the SLA accurately, appropriately and fairly.
• Manage team to support Fax claim role and responsibility for weekend.
• Development of professional health claim service
• Develop and reviews for update claim assessment standards and re-assessment guide.
• Develop and coaches team member in medical or assessment knowledge to enable individual handles more complex cases.
• Conduct Pre and Post-assessment program to validate the appropriate judgment, and eliminate omitted payment.
• Participateinthedevelopmentofnewproductsandprovidecommentsand suggestions aboutclaimviews/partof claim with the product development team.
• ContactandcollaboratewithRE-InsurerabouttheclaimTreaty.
• Loss ratio or total health claim management
• Identify red flag of hospital or distributor which the health claim expense trend or fraud claim is high or highly increasing.
• Execute action plan of health claim management program to increase effectiveness of claim expense control.

Qualifications

• Bachelor or Master degree in Medical related field
• Certification / License in LOMA, ICA etc.
• Experience At least 12-15 years experienced in health claims and recent position at manager or higher level for 2-3 years
• Experience in dealing with hospital, reinsurer, complaint clarification and negotiation at OIC and other external firms is required.
• Good Communication in Thai and English