Manager - Life Claims at Great Eastern Life Assurance Co Ltd

Cuenca, Azuay, Ecuador -

Full Time

Start Date

Immediate

Expiry Date

11 Jun, 26

Salary

0.0

Posted On

13 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Assessment, Medical Knowledge, Policy Terms Adherence, Regulatory Requirements, Legal Matters, Medical Professionals Engagement, Stakeholder Management, Process Improvement, Mentoring, Risk Mitigation, Business Acumen, Integrity, Accountability, Analytical Skills, Problem-Solving, Customer-Centric

Industry

Insurance

Description

We are seeking a highly skilled and detail-oriented professional to join our Life Claims team as a Senior Claims Assessor. This role is critical in ensuring the accurate and timely assessment of legitimate life insurance claims, while upholding the highest standards of service and compliance. The role will also be given the opportunity to be part of an exciting team with involvement in service excellence initiatives and projects to improve the claims experience. The Job 1. Manage and assess life claims, including appeals with sound medical knowledge and adherence to policy terms. 2. Ensure timely and accurate claim decisions in line with service standards, regulatory requirements and legal matters. 3. Engage with medical professionals, hospitals, policyholders and claimants to obtain necessary documentation and clarify clinical details for claim evaluation to achieve timely closure and resolution. 4. Deliver excellent service and enhance customer and distribution channels relationship management. 5. Collaborate with internal stakeholders to improve claims processes and contribute to continuous improvement initiatives. 6. Mentor and guide junior staff. 7. Undertake additional responsibilities as assigned by the supervisor, demonstrating flexibility and commitment to organizational needs. 8. Take accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks 9. Maintain awareness of industry trends on regulatory compliance, emerging threats and appropriate steps to mitigate the risks 10. Highlight any potential concerns/risks and proactively shares best risk management practices · Degree with at least 8 years of experience in life claims assessment or with relevant experience. · LOMA (ALMI Level) and ICA Associate certifications are required. · Strong understanding of medical terminology including of ICD and CPT codes, life insurance claim practices and insurance policies. · Excellent communication and stakeholder management skills. · Strong analytical, meticulous and good problem-solving skills · A positive and motivated individual who is customer-centric and meticulous with the ability to work under pressure. · A team player. · Good business acumen with long term vision. · High level of integrity, takes accountability of work and good attitude over teamwork. · Take the initiative to improve the current state of things and adapt to embrace new changes.

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Responsibilities

The role involves managing and assessing life insurance claims, including appeals, ensuring timely and accurate decisions while adhering to policy terms and regulatory standards. Responsibilities also include engaging with medical professionals and stakeholders to gather necessary documentation and contributing to service excellence initiatives.