FIND YOUR 'BETTER' AT Blue Cross

We don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us.

We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.

If you believe in better, we’d love to hear from you.

About the Role

Lead the team to effectively manage medical claims to achieve claims KPIs. Including complicated claims approval, disputed claims and claims case complaints handling with flexible solutions. Regular data and report management with improvement actions, sound quality controls to achieve audit and regulatory requirements. This role is also responsible for delivering exceptional customer experience in claims, meeting the Company’s overall strategic and operational goals.

Responsibilities:

Lead the claims team to effectively manage medical claims to achieve claims KPIs.Monitor the claims operation and approve complicated claims in accordance with the established procedures and guidelines.Supervise subordinates’ and provide guidance to junior staff members to ensure their performance are up to the Company’s requirements.Appeal and complaint case handlingConduct thorough review and investigations to identify the root cause and provide feasible solutions.Regular data and report managementConduct analysis on claims data and produce regular reports for clients and management review.Participate in service review meetings with client groups or healthcare providers, attend staff benefit briefing sessions and conduct site visits to service provider facilities as required.Performs other responsibilities and duties periodically assigned by immediate manager in order to meet business requirements.

Requirements:

University degree in any disciplines with minimum 10 years’ medical insurance or claims experience.5 years or above at supervisory level with in-depth knowledge of medical claims.Possesses relevant insurance professional qualification such as ACII / ANZIIF (Senior Associate) / FLMI / FLHC or other related insurance professional qualifications is an advantage.Good communication skills, able to explain claim process & decision to various stakeholders.Proficient in MS Office and Chinese Word Processing.Good command of both written and spoken English and Chinese.Good problem-solving skills, strong management and organizational skills are essential.Customer-oriented with excellent interpersonal and collaboration skills.

Others:

You are required to obtain relevant license if your job involves in regulated activities

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.