claims appeal & complaints sr. ManagerAXA MANDIRI FINANCIAL SERVICES

Job Description
Job Purpose
.Directly responsible for handling claims appeals and complaints from internal and external customers within the agreed turnaround time in adherence to the Appeals and Complaints Guidelines.
.Investigate claim concerns as initiated by Insurance Commission (IC) and respond within IC's standard turnaround time.
.Represent AXA in Insurance Commission's mediation conference on claims related concerns.
.Endorse and monitor claims related legal cases.
.Collaborate with Claims department to resolve issues and concerns in an efficient and timely manner.
.Inform Retail Distribution of the appeals and complaints findings particular to the distributors and provide recommendations as learning opportunity.
.Attend client meeting to discuss the appeal or complaint and perform service recovery.
.Prepare appeal cases and provide recommendations to the Claims Committee based on the information gathered from Claims and other departments involved.
.Ensurethatthe resolution provided is inaccordancewith the existingPhilippinelife insurancelawsandstatute.
.Ensure that appeals and complaints related communications being sent to the internal and externalstakeholders are appropriate and timely.
.Analyze data related to appeals and complaints and identify trends or areas for improvement.
.Take charge of and work closely with other teams within Claims for future strategies or initiatives to reduce appeals and complaints and improve the overall customer experience.
.Represent Complaints and Appeals in special initiatives or projects that will impact the operations of the department (e.g. IT-related projects or system enhancements, legal and complianceinitiatives).
.Coordinate with Claims and other departments to ensure completion of project and monitor its progress.
.
Critical Accountabilities
Key Result Areas
Major Activities
Output
Challenges and Risks
Service Management
.Directly responsible for handling claims appeals and complaints from internal and external customers within the agreed turnaround time in adherence to the Appeals and Complaints Guidelines.
.Investigate claim concerns as initiated by Insurance Commission (IC) and respond within IC's standard turnaround time.
.Represent AXA in Insurance Commission's mediation conference on claims related concerns.
.Endorse and monitor claims related legal cases.
.Prepare appeal cases and provide recommendations to the Claims Committee based on the information gathered from Claims and other departments involved.
.Ensurethatthe resolution provided is inaccordancewith the existingPhilippinelife insurancelawsandstatute.
.
.
Operational Support
.Collaborate with Claims department to resolve issues and concerns in an efficient and timely manner.
.Analyze data related to appeals and complaints and identify trends or areas for improvement.
.Take charge of and work closely with other teams within Claims for future strategies or initiatives to reduce appeals and complaints and improve the overall customer experience.
Staff and Distributor Empowerment
.Inform Retail Distribution of the appeals and complaints findings particular to the distributors and provide recommendations as learning opportunity.
Stakeholder Management
.Ensure that appeals and complaints related communications being sent to the internal and externalstakeholders are appropriate and timely.
.Attend client meeting to discuss the appeal or complaint and perform service recovery.
.
Project management
.Represent Complaints and Appeals in special initiatives or projects that will impact the operations of the department (e.g. IT-related projects or system enhancements, legal and complianceinitiatives).
.Coordinate with Claims and other departments to ensure completion of project and monitor its progress.
Your Profile
Preferably a graduate of any medical or allied medical degree.
At least 2 yrs experience in life, health and medical claims adjudication.
Excellent written and oral communication skills with the ability to effectively articulate life insurance terms and conditions as well as the convey the reason for claims decision.
Detail oriented and highly organized. Team player and at the same time efficiently do tasks in silo.
Above average level of knowledge in insurance operational processes.
Customer centric and must advocate the Customer First mindset.
Highly developed sense of integrity.
Pleasant, patient and friendly attitude sociable personality. Able to relate to work colleagues from different backgrounds.
Good negiotiation and influencing skills.
About AXA
A global leader in insurance and investments, AXA takes care of 103 million lives in 64 countries worldwide. We actively invest in pioneering and personalized solutions to meet your ever-changing needs and exceed your expectations. In the Philippines, we are in partnership with Metrobank, one of the country's strongest banks.
About the Entity
Established in 1999, AXA Philippines is one of the largest and fastest growing life insurance companies in the country. It offers financial security to more than one million individuals through its group and individual life insurance as well as general insurance products through its subsidiary Charter Ping An.
AXA Philippines is one of the first to introduce bancassurance operations in the country, and is among the pioneers in the investment-linked insurance sector.
AXA now offers a complete range of products for all its customers insurance and financial protection needs, including savings and investments, health plans, income protection, and health coverage and through its general insurance subsidiary Charter Ping An Insurance Corporation: fire, motor car, marine cargo, personal accident, bonds, casualty, and engineering insurance products.
AXA Philippines closed 2017 with P26.4 billion in total premium income and P5.7 billion in gross written premiums from Charter Ping An. Today, AXA has more than 4,000 financial advisers in 36 branches, and 700 financial executives in over 900 Metrobank and PSBank branches nationwide. Charter Ping An, on the other hand, has 22 branches nationwide and 2,007 agents.
AXA Philippines is a joint venture between the AXA Group, headquartered in France, and the Metrobank Group, one of the largest financial conglomerates in the Philippines.
The Metrobank Group is a conglomerate of industry-leading businesses that includes First Metro Investment Corporation, Metrobank Credit Cards, Federal Land, Toyota, and Manila Doctors Hospital. It was hailed Best Bank in the Philippines in 2010, 2011, and 2012 by Euromoney and recognized as the strongest bank in the Philippines by The Asian Banker in 2013. It is owned by the Ty Family whose major business interests include financial services, real estate development, power, and manufacturing.
What We Offer
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