Role Title: Supervisor – Claims & Approvals
Role purpose summary: Manage and lead the claims activity across all lines of business. Ensure that SOP’s are followed and undertake remedial action where required. Optimize the effectiveness of the claims process for the business.
Key responsibilities and accountabilities:
- Supervision of assigned staff including, ensuring that company procedures are followed, resolving procedural or personnel problems.
- Manage claim activities of field and office personnel; assign, direct and supervise the investigation and proper claims disposition including maximizing efficiency; maintain records of and review workload distribution.
- Provide daily supervisory support by answering staff questions, providing feedback, and providing training.
- Reply to questions and claim complaints from policyholders, claimants, and agents as a primary point of escalation.
- Generate and supervise written communication to the insured, claimants, clients, agents and other key stakeholders.
- Compile periodic and special reports, attend and participate in meetings as require.
- Routinely assume direct handling of some files, assume direct handling of additional files when needed by the group due to workloads and/or staffing, and temporarily assume handling of files when direct reports are of the office.
- Confer with attorneys, experts, and others in the settlement of claims.
- Authorize and approve settlement of claims within designated limits; escalate claims via appropriate channels, which exceed designated authority.
- Handling (In Patient & Out Patient), auditing & Monitoring the work of the medical and the client services teams, monitoring the quality of the provided services, training the medical staff, High cost approvals assessment and managing all the escalations and /or complaints.
- Arranging the approval & call center timings and duty hours according to the work needs .
- Coordination with the providers’ medical management and their the insurance managers / staff to assure providing the best level of the services to our clients.
- Representing the company in the client audits, medical seminars and preparing the medical presentation & visiting clients for scheduled meetings.
- The above list of responsibilities is not exhaustive and you may be required to undertake other responsibilities and training as requested by your line manager, appropriate to your grade and commensurate with the business need.
|Job Location:||Al Kuwait, Kuwait|
|Career Level:||Mid Career|