Assistant Manager, Claims-A&H

Responsibilities:

a) Daily Routine (60%)

• Processing Accident & Health claims to enable that all steps aligned with SOP and agreed SLAs
• Provide consultation to team on daily basis of operational process, give direction on complex and sensitive cases during absence of manager, after office hours or holidays
• Coordinate with Internal Auditor (IA) to close identified gaps and reported issues
• Coordinate with internal & external stakeholders (Marketing, Sales, Brokers, Agent), provide proper assistance and handle their inquiry
• Responsible for complaint escalated by Customer Service, Marketing or Regulatory (OIC)
• Collaborate with Provider Management team to solve medical provider issues and may visit panel hospital if necessary
• Review claims process and proposes ideas to improve working process, proactively report process issues that need further enhancement and development, including system UAT
• Overseeing AH Claim’s customer services to ensure that team delivery best customer experience every touchpoint on each sage of claims
• Assist and support manager to monitoring and tracking staff performance, productivity, KPIs to ensure “ZERO” backlog
• Coordinate with HR, IT when onboarding staff, prepare mandatory request and obtain access permission
• Conduct training to new staff or existing staff as assigned
• Overseeing team and ensure that customer enquiry through email, calls, etc. being handled on timely basis
• Manage staff roster and WFH schedule and OT planning

b) Loss Prevention & Quality Assurance (20%)

• Identify cost savings opportunities before and during the hospitalization claims
• Negotiate additional saving with network hospital at pre-invoice (IPD) & post-invoice
• Proactive identify opportunity to steering the case from high-cost facility to preferred provider at reasonable charges
• Conduct cost containment and ensure that medical treatment done at proper utilization and customary price
• Initiatives monthly claims retrospective review, quality assurance for A&H internal & business partner (APRIL), collaborate with Quality Improvement team to solve issues
• Collaborate with Product & Underwriting on “Loss Prevention & Control”
• Coordinate with business partner (APRIL) team to handle high cost claims
• Document error claims including tracking claw back or recovery where applicable and create proper tools to monitoring

c) Project & Initiatives (20%)

• Participate AH Claims project & initiatives e.g. Claims Report Portal and Automation, Claims Auto Decision, Customer Notification (SMS & Email) or other projects as assigned by Manager
• Conduct UAT and coordinate with IT on bugs fixing
• Attend meeting with IT and provide user requirements
• Submit IT ticket requests and follow-up

Qualifications / Specific Requirements:

• Bachelor’s in Nursing, Medical Technology, or other related medical fields
• 5 years of health insurance experience and at least 3 year in claims assessment and processing
• Detail orientation, Problem-solving, negotiation, and decision skills
• Good communication and interpersonal skills with service attitudes
• Self-motivated, independent, and able to work under pressure
• Familiar with MS Office applications
• Intermediate in written & spoken English
• Good team player

About LMG Insurance Thailand

LMG Insurance in Thailand is a 100% owned subsidiary of the Liberty Mutual Insurance Group. Headquartered in Boston, Liberty Mutual Insurance Group is a diversified global insurer and the fifth largest property and casualty insurer in the U.S based on 2022 gross written premium. It ranks 86th on the Fortune 100 list of largest corporations in the U.S. based on 2021 revenue. As of 31 December 2022, Liberty Mutual Insurance Group had US$50 billion in annual consolidated revenue.

LMG Insurance Public Company Limited previously named Narai International Insurance Co. Ltd.,

The company was established on 27 November 1975. In 2003 the company merged with Kum Klao Insurance Public Co. Ltd. On 6 September 2004, the company registered under the new name of LMG Insurance Company Limited. On 2 July 2012, then the company was listed as a public company - LMG Insurance Public Company Limited.

Our years commitment to offering the highest level of service to our customers has propelled LMG Insurance Public Company Limited into one of the top rank position in the Thai insurance market, with a reputation for trust and reliability that extends countrywide. Its financial stability is unparalleled with about THB 1,700 million in authorized capital and the support of Liberty Mutual Insurance of the USA, one of the world’s leading insurance providers.

We employ over 50,000 people in 29 countries and economies around the world. Every role at Liberty Insurance is essential to our mission of helping people embrace today and confidently pursue tomorrow.

Join us and take the opportunity to advance your career.