Job Description

FIND YOUR 'BETTER' AT Blue Cross

If you believe in better, we’d love to hear from you.

About the Role

Responsible for determining the validity and authorising settlement of group health insurance claims

Duties:

  • Pro-actively handle claim cases, including timely investigation into suspicious abuse claims, cost-effectiveness engagement of service providers, regular claims follow up, provide guidance and coaching to subordinates on claims, insurance / risk issues and performance;
  • Assess, handle and approve all claims types and authorize claims payment within authority and refer claims beyond authority to the Head of Claims / Manager providing sound recommendations;
  • Draft effective correspondence for complex coverage positions;
  • Handle claims appeals, complaints, reinsurance / third party recovery claims in the best interest of the Company;
  • Work with the Head of Claims / Manager to monitor and conduct asse...

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