Supervisor – Claim Operations

Summary of the Role

The Medical Claim Supervisor oversees the medical claims team, ensuring efficient, accurate, and end‑to‑end compliant investigations. This leadership role involves managing team performance, implementing process improvements, and ensuring exceptional service delivery while aligning with goals and regulatory standards.

Responsibilities

• Leading and mentoring the Medical Claims team, setting performance goals, and monitoring KPIs.
• Review and assess medical claims, ensuring alignment with policy guidelines and service standards.
• Review and process complex claims cases and handle escalated cases from team members.
• Prepare and analyse claims data and reports.
• Collaborate with HK Claims Team to conduct assessment and investigation if needed.
• Provide guidance and support to facilitate junior advisors in service delivery and daily operations.
• Drive continuous improvement initiatives to optimize claims processing workflows.
• Provide trend analysis of suspicious cases to suggest an FWA detection framework.
• Update SOP and training notes.
• Perform daily QC to ensure the team's accuracy.

Desired Professional Experience

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