Job Description
FIND YOUR BETTER AT AIA
If you believe in better, we'd love to hear from you.
WE ARE LOOKING FOR .....
The Quality Associate is accountable for the highest level of accuracy before a claim is paid-out to the insured. The role drives the discipline in balancing The Quality Associate is accountable for the highest level of accuracy before a claim is paid-out to the insured. The role drives the discipline in balancing customer turnaround times and quality in all transactions processed through coaching and driving team initiatives to improve accuracy.
The role ensures that claims are paid accurately to the correct claimant (insured and beneficiary), for the right amount and according to the provisions of the policy. The Quality Associate then ensures disbursements are accurate before uploading for final approval.
Ensures that the claims assessed by the makers are aligned with the provisions and standard processing of claims. This includes analysis of the correct amount and the correct claimants.
Checking is based on the Claims QA Checklist. The checklist includes the following:
Checks the appropriate tools against the submitted documents
Ensures the critical information is entered correctly
Ensures the insured and beneficiaries are paid based on the insurance policy coverage and provisions of the contract
Checked items is the basis of the Assessor's monthly Quality Goal of 98% which constitutes 35% of the Assessors PDD
Sends back the claim item to the assessor if any changes or corrections need to be done
Delivers coaching to assessors using a coaching form and follows through on action plans agreed on during the coaching session
Provides performance management recommendations to Claims manager based on the coaching sessions conducted
Comes-up with error trending and initiatives to improve quality scores. Facilitates regular calibration meeting with the team.
Serves as the team's Subject Matter Expert
Ensures that claim has been properly booked prior to pay-out
Endorses the claim for disbursement
When assigned as a JETT Maker: Ensures timely processing of Claims benefit pay-out by creating disbursements files, uploading on the system and assessing flags and taking appropriate actions.
When assigned as a JETT Checker: Ensures disbursement file for upload are accurate by doing 100% QA of all the items for upload
Provides list of the batches that were uploaded for reference of the checkers and approvers. Able to prepare requests immediately as needed.
Process BAU related request (e.g: fallouts, reprocessing of rejected request, cancel and replacement, etc.)
Prepare quality reports and provide insights on error trending and action reduce errors
Work closely with Claims Manager to manage performance of Assessors
Coach assessor based on the error findings
Assists in audit requirements by providing reports and evidence required by auditors
Serves as resource for training when needed
This position is responsible in communicating error trends to management and assist in coaching assessors and provide recommendations for performance management
QUALIFICATIONS
At least 3 years work experience in Claims processing
Experience in Claims Checking, is preferred
Keen to details and Innovative
Flexible to work overtime and can manage large volume of requests
Proficiency in MS Office
Ability to perform other task such as: computer troubleshooting Basic knowledge in system/behaviour/programming language
Individual contributor but should be a team player
FIND YOUR BETTER AT AIA
If you believe in better, we'd love to hear from you.
WE ARE LOOKING FOR .....
The Quality Associate is accountable for the highest level of accuracy before a claim is paid-out to the insured. The role drives the discipline in balancing The Quality Associate is accountable for the highest level of accuracy before a claim is paid-out to the insured. The role drives the discipline in balancing customer turnaround times and quality in all transactions processed through coaching and driving team initiatives to improve accuracy.
The role ensures that claims are paid accurately to the correct claimant (insured and beneficiary), for the right amount and according to the provisions of the policy. The Quality Associate then ensures disbursements are accurate before uploading for final approval.
Ensures that the claims assessed by the makers are aligned with the provisions and standard processing of claims. This includes analysis of the correct amount and the correct claimants.
Checking is based on the Claims QA Checklist. The checklist includes the following:
Checks the appropriate tools against the submitted documents
Ensures the critical information is entered correctly
Ensures the insured and beneficiaries are paid based on the insurance policy coverage and provisions of the contract
Checked items is the basis of the Assessor's monthly Quality Goal of 98% which constitutes 35% of the Assessors PDD
Sends back the claim item to the assessor if any changes or corrections need to be done
Delivers coaching to assessors using a coaching form and follows through on action plans agreed on during the coaching session
Provides performance management recommendations to Claims manager based on the coaching sessions conducted
Comes-up with error trending and initiatives to improve quality scores. Facilitates regular calibration meeting with the team.
Serves as the team's Subject Matter Expert
Ensures that claim has been properly booked prior to pay-out
Endorses the claim for disbursement
When assigned as a JETT Maker: Ensures timely processing of Claims benefit pay-out by creating disbursements files, uploading on the system and assessing flags and taking appropriate actions.
When assigned as a JETT Checker: Ensures disbursement file for upload are accurate by doing 100% QA of all the items for upload
Provides list of the batches that were uploaded for reference of the checkers and approvers. Able to prepare requests immediately as needed.
Process BAU related request (e.g: fallouts, reprocessing of rejected request, cancel and replacement, etc.)
Prepare quality reports and provide insights on error trending and action reduce errors
Work closely with Claims Manager to manage performance of Assessors
Coach assessor based on the error findings
Assists in audit requirements by providing reports and evidence required by auditors
Serves as resource for training when needed
This position is responsible in communicating error trends to management and assist in coaching assessors and provide recommendations for performance management
QUALIFICATIONS
At least 3 years work experience in Claims processing
Experience in Claims Checking, is preferred
Keen to details and Innovative
Flexible to work overtime and can manage large volume of requests
Proficiency in MS Office
Ability to perform other task such as: computer troubleshooting Basic knowledge in system/behaviour/programming language
Individual contributor but should be a team player
Submit profile
AIA Group
About the company
AIA Group jobs
Philippines
Position Quality officer recruited by the company AIA Group at Taguig, Joboko automatically collects the salary of , finds more jobs on Quality Officer or AIA Group company in the links above