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Offshore Claims Consultant

Primary Location: Singapore, SGP
Additional Locations: SGP-Singapore
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Description:
Job Group Summary
Fast, accurate claims payment is one of the ways we make a difference in people's lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it's most needed.

Family Summary/Mission
Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations.

Position Summary/Mission
The Offshore Claims Consultant role operates across our Regional footprint (Singapore, Indonesia, Vietnam, Philippines) and with our Vendor(s) (Philippines & India) to ensure the smooth, scalable, and cost‐efficient running of our Operations functions on behalf for our members in VT, PH, and ID. This role will work directly with regional operations teams, and vendor managed teams, to deliver a high quality, consistent service wrap for our SEA members. This role will be accountable for the E2E Claims performance for SEA markets, including managing the day to day claims volumes, escalations, high-cost claims adjudication, producing reports, working suspend and pend reports, communicating outcomes, and keeping stakeholders updated.

This role is critical to our SEA business, ensuring the consistent and timely support of all their member's support needs, but especially focused on claims performance. In addition, this role will need to work closely with the SEA markets to understand and align on any specific requirements. The SEA service model must be simple, measurable, and deliver high-quality member experiences within our agreed SLAs, with a year on year objective to maintain and improve quality standards, whilst driving efficiency.
In this role, you will also use your experience to tackle service issues. You will need to work across many different stakeholders to understand the issues, drive to a proposed solution that works for all parties, and then lead the execution/implementation through to measuring the business benefit.

Fundamental Components & Physical Requirements
  • End‐to‐end ownership of claims processing for Philippines and Vietnam books of business, including overall inventory management, achieving TATs, management of suspending & pend volumes, quality control, and customer outreach.
  • Single Point of Contact for HGS teams (MST Manila & Claims India), PH & VT SAM, Regional & Global claims team interlock. Personally responsible for the error handling, query resolution, rework, complex, and high cost claims processing.
  • For these markets, a majority of claims are being submitted by email via the broker. These claims are scanned by MST Manila to create and upload to a DME. Claims investigation is required for illegible and missing claims. This role will work across MST Manilla and HGS India Claims and coordinating with local, in‐market teams to resolve the issues.
  • Report management:
Tiger Resort comes with a contractual requirement for a fortnightly claim status & inventory report
Region-specific claims report
Turnaround time report which we are currently not producing for PH & VN as it is manual in nature and no available resource.
  • Monthly audits of completed QA results (processed by HGS & VN onshore) with follow up actions identified and carried through in a timely manner
  • In‐Region Provider claims audit/reconciliations
  • Provides informal guidance to colleagues
  • Contributes to the achievement of team objectives
  • Contributes to the resolution of moderately complex problems.

Background Experience Desired
  • 5+ years claims management experience
  • Demonstrated critical thinking skills
  • Excellent written and verbal communication skills
  • Good collaborative skill and able to work with offshore teams to drive results
  • Proven track record of building and sustain business relationships across complex/matrix organizations.
  • Capable of identifying performance improvement opportunities
  • Demonstrated ability to solve problems independently, with a strong track record of successful customer service/stakeholder management experience
  • Experience with claims technology and leading industry practices a plus.
  • Excellent written and verbal communication
  • Strong Excel skills a must


EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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