life claims OfficerAXA

Adjudicates and approves claim that fall outside Level 1's authority limits, cases that require special handling, or claims submitted for and/or by VIP customers as defined in the Life Claims Business GuidelinesAdjudicates and approves Death, Critical Illness, Daily Hospitalization Income, Accident Medical Expense reimbursement, Waiver of Premium, Accidental Death & Disability, Permanent Total Disability, and Terminal Illness Benefit claims from the retail (individual) and/or group lines of business within your delegated authority limits and stipulated turnaround timeConducts the end-to-end claim case management from claims adjudication to the timely emailing of the decision letter to the claimant and/or distributor using WFI, RLS, iBPS, SCRM, MAP, and MS Outlook as work toolsAssist Claim Officers, as needed, in conveying the relevant claim terms and conditions with properly identified claimants and/or distributors, via email or a virtual meeting, when encountering objections to the process of obtaining supporting documentsReviews and analyzes insurance policies, product technical notes, medical records, and other documentation to determine whether the claim is approved, denied, or needs additional documents.Complies with set policies and procedures in the identification of and prevention of losses due to fraudulent claimsEnsures complete and accurate claim documentation by asking for and obtaining relevant information that will help arrive at the appropriate claim decision. Ensures that all relevant case notes, documents, and correspondences are available in the WFI case file and RLS claim assessment modulePrepares the complete case summary for claim referral to Level 3, or higher, for cases where the total payable benefit exceeds your delegated authority limits. Makes recommendation on the provisional claim decision on such casesAssesses the precise payable amount for the claim benefit (work) type after determining the applicable deductions or additions, if any, using the computing tools provided by AXA PhilippinesQualificationsBachelor's degree holder of any 4-year course, preferably in the medical sciences, and have at least 5 years of experience in life claims processing or life insurance operations.Detail-oriented and analytical. You can draw sound judgment and take a decision on the facts being presented in the claim documentation available to you without missing the important details in the documentation.Self-driven, motivated individual who shares a commitment to delivering exceptional customer service and provide timely resolution on complex cases.Highly organized individual who can easily keep track of your responsibilities, deadlines, and promises made to a claimant and/or distributor.Works professionally and ethically with department colleagues, clients, claimants, vendors, and distributors.
AXA

Philippines
Permanent
Full-time