JOB PURPOSE Manages the efficient delivery of claims management functions to cater to the operational requirements of Micro HMO.
ROLES AND RESPONSIBILITIES Customer and Provider Experience (Claims) Manages the team's consistent and efficient delivery of member availment services and provider billing settlement by meeting Service Level Agreements to ensure positive customer and provider experience. Maintains effective communication and good relationship with customers, providers, internal stakeholders, and other parties involved in the member availment and provider billing settlement processes. Process Management Supervises the claims team to deliver their functions according to agreed-upon quality standards and turn -around time such as processing of claims availment from the members; processing of billing from providers and assisting claimants with availment-related concerns. Facilitates periodic process reviews with the team and recommends solutions to the Operations Head to address challenges and opportunities for improvement. Monitors the team's resolution of all claims-related concerns and makes appropriate actions and decisions, when needed, to ensure that established Service Level Agreements are consistently met. Leads the team to comply with customer service standards in all aspects of operations. Talent Management Manages the workforce planning (appropriate structure and jobs), capacity building, and manpower distribution of the team to execute business strategies. Performs people management functions (such as, but not limited to, hiring standards, onboarding, performance management, talent development, etc.) to direct reports for productivity, growth, & succession. Implements organization culture initiatives in the team consistent with the whole Pioneer Group. Data Management Oversees the collection and storage of required documents and monitors their completeness and validity. Implements and monitors the team's compliance to Pioneer's data management standards, policies, and procedures. Oversees the delivery of routine and on-demand reports and monitors their compliance with the agreed-upon SLA. QUALIFICATIONS Graduate of bachelor's degree course preferably in business administration, insurance management or any related course. With at least 5 years relevant and progressive work experience. Preferably gained in HMO industry specifically in the rural market. With experience in start-up company/project is an advantage. At least 2 years of progressive management experience in managing contact center specialist working in shifting schedules. Proficient in the MS Office (work, excel, PowerPoint) Above average English communications skills both oral and written)
