junior claims analyst - InsuranceShopee

Job Description
Job Description:
Conduct daily claims team functions in coordination with local and regional teams
Obtain details required to assess the validity of claims and identify the parties responsible for accidents, damage, and loss, with an expert understanding of the processes of claim validation
Interpret basic policy coverage, and determine if coverage applies to claims submitted, escalating issues as needed
Engage in fraud prevention analysis and develop investigative guidelines to serve as standard for claims risk management
Support quality assurance and user acceptance testing (UAT) efforts working with relevant stakeholders to ensure alignment with system and customer requirements
Work alongside business and cross-functional teams to constantly optimize the operational processes and product experience of the internal and external users
Manage network activities (Hospital and Motor and Equipment repair shops)
Requirements:
Bachelor's Degree in Finance, Commerce, Accounting, or any medical field
Minimum of 5 years of experience in a Life Insurance firm. Experience with general and health insurance products is preferred
Good understanding of local life and health insurance product market, including main claims processes and main technology tools used to manage claims in a large-scale insurance setting
Understanding of health-related claims and overall Filipino health service systems (i.e. public/private healthcare, clinics, other providers) network
Good understanding of local regulatory requirements, particularly from a claims perspective