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Senior Executive, Claims & Provider Management

Keywords / Skills : Senior Executive, Claims & Provider Management

Posted: 2019-11-05

Industry
Banking/Accounting/Financial Services
Function
Customer Service/Call Centre/BPO
Role
Customer Service Executive
Posted On
5th Nov 2019
Job Ref code
R-87111
Job Description
CONTEXT
  • Aviva Ltd is a Tier 1 insurer with over SGD 5 billion of assets under management covering 1.4 million customers. The Company is a fully owned subsidiary of Aviva plc, a global leader and UKs largest insurer. Serving the Singapore market since 1855, in 2001, the acquisition of the Insurance Corporation of Singapore strengthened the Companys presence in Singapore and in 2002, we became Aviva
  • The Singapore Insurance landscape is highly regulated and concentrated with 79 direct insurers; 17 Life, 57 General and 5 Composite Insurers. Aviva Ltd is a Composite Insurer and one of the leading providers of retirement, investments, insurance and health solutions in Singapore. Our purpose is to free people from fear of uncertainty
  • The Company is a provider of Medisave-approved Integrated Shield plans as well as an appointed insurer for the national ElderShield scheme, and we constantly find innovative ways to enhance our products, ensuring they remain relevant to our customers needs
  • Being the pioneer general insurer in Singapore to offer motor, travel and home insurance solely via the internet (aviva.com.sg), we offer simplicity, convenience and cost savings to customers
  • Aviva is one of the biggest providers of employee benefits and healthcare, including protecting Singapore Armed Forces servicemen since 1983 as well as being the appointed insurer for the Public Officers Group Insurance Scheme (POGIS)
  • Our funds administration solution, Navigator, with its wide variety of funds, remains one of the preferred investment platforms in Singapore
  • The Company has a robust governance structure covering Board, Audit, Risk, and Asset & Liabilities Committees
PURPOSE OF THE ROLE
Provider Networks and Third-Party Vendors Management:
  • Provide full spectrum of healthcare related provider management services including provider selection, recruitment, engagement, provider relationship and utilization management for Aviva business operations in Singapore.
  • To be the main liaison for operational dealings with various healthcare related providers with the objective of supporting Aviva business operations in Singapore.
  • To present managed network facilities to clients/brokers in Singapore.
  • To conduct training to third party administrators to equip them with the knowledge in supporting our business.
Claims Management and Claims Operations:
  • As a Technical Specialist to provide claims advisory to Group Life & Health Claims team on the management of panel claims
  • Establish appropriate claims guidelines to aid the claims assessment and achieve standardization in claims assessment and management
ACCOUNTABILITY
Strategic
  • Manage designated Group Life & Health Claim & Provider Management Section to achieve Team, Department and Company goals
  • Timelines in reports preparation and completion of assigned tasks
  • Responsible for promoting an environment where a risk management culture can flourish
  • Monitor changes & quality of care from panel of providers and recommend and take appropriate action in order to contain claims cost
  • Plan initiatives for understanding provider related issues and undertake prompt action to resolve the issues in order to provide superior service to customers
  • Negotiate pricing, rebate and other terms and conditions with providers in order to obtain the best possible deal for the company
  • Identify and recommend any process/operational enhancements or new service propositions in order to improve efficiency and customer service
  • Responsible for promoting an environment where a risk management culture can flourish
Operational
  • Meet the quality, corporate and strategic goal set by the department and the company
  • Ensure proper claim handling and proper channel of documentation so as to avoid unnecessary legislation
  • Ensure proper maintenance of claim documentation in preparation of audit
  • Meet the turnaround time / target time in claim handling according to companys service agreed standard
  • Ensure Customer Satisfaction
  • Ensure smooth functioning of the process flow of Provider Management Section
  • Provide good understanding about Managed Care Network facilities to internal teams, clients and brokers through presentations
  • Complete due diligence formalities with all new and existing providers in order to be in line with the companys risk management standards
  • Investigate and address the complaints of customers in using our panel network in an effective and prompt manner in order to be consistent with the companys fair dealing outcomes
  • Create and maintain a risk management environment that ensures risk taken by the function are identified, assessed and frequently monitored, managed and reported against
KEY PERFORMANCE INDICATORS
People
  • Check and approve claims to ensure claims are processed correctly according to Policys terms and benefits
  • Monitor performance of claims officers / executive
  • Provide training to both claims officers and customers
Customers
  • Establish relationship with clients, brokers and medical providers
  • Customer satisfaction
RELATIONSHIPS
(Internal & External)
  • Business, Policy Servicing and System Support units to ensure appropriate claims handling
  • Doctors, Diagnostic Centers, Hospitals and Third Party Administrators to provide cost effective and quality cares
  • Third Party Administrators including Outsource vendors


About Company

We help our 33 million customers to save for the future and manage the risks of everyday life. To give these customers the best possible products and service we know we must make Aviva the most attractive choice for talented, entrepreneurial people with diverse backgrounds and an evolving range of expertise and insight.So, were passionate about helping our 29,500 people to do the best work of their lives, to enable them to make a positive difference to the lives of our customers.
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