Expert, Claims Management (Techcom Insurance)

Trách nhiệm chính

• Evaluate and process high‑complexity insurance claims, including death benefits, critical illness cases, and disputed accident claims.
• Examine completeness and logic of all documents such as policies, medical records, incident reports, death certificates, and legal paperwork.
• Analyze operational risk points and recommend resolution strategies, including documentation requests, escalation pathways, or coordination with independent assessors.
• Act as technical lead for claims requiring internal review of benefit eligibility, product terms, or regulatory interpretation, providing detailed written assessments and recommendations.
• Handle escalated disputes involving claim payout decisions, benefit mechanics, or beneficiary conflicts with professionalism and attention to detail.
• Contribute expert evaluation to new product development discussions, identifying claims risk areas and operational gaps.
• Work directly with Audit and Reinsurance departments to review processed cases, especially high‑payout claims or those requiring shared liability analysis.
• Utilize specialized claims systems for data entry, assessment, decision‑making, and recording professional comments in line with compliance standards.
• Propose upgrades to operational tools such as expert‑level checklists, early risk alert systems, customer advisory templates, and intelligent case categorization features.
• Assist senior management in handling claims cases with legal sensitivity, public auditability, or reputational significance by providing objective, structured analysis.
• Train frontline staff in advanced technical aspects, including medical record interpretation, document authentication, and identification of fraud or legal risk indicators.
• Collaborate closely with strategic departments such as Underwriting, Legal, Product Management, Reinsurance, and Customer Service in handling, reviewing, and approving complex claims cases.
• Serve as technical lead in resolving interdepartmental issues including benefit interpretation, exclusion application, contested claims, or legal risk concerns.
• Represent the technical function in specialized meetings, sharing in‑depth case analysis, workflow updates, and critical feedback on newly proposed claims policies.
• Act as advisor to frontline teams, offering expert guidance on sensitive claims assessments and shaping verification methodologies, especially for death and serious illness cases.
• Contribute to internal training materials: multi‑tiered claims workflows, cases involving medical/legal assessors, and guidelines for beneficiary conflict resolution.
• Help develop peer auditing models across specialist groups to standardize evaluation protocols based on benefit type and claim risk level.
• Work with IT or Operations departments to upgrade automation checks, intelligent case categorization, and integrated tools for policy–claim–beneficiary validation.
• Propose workload segmentation models based on technical complexity, risk tiering, and payout value to optimize resource use and raise process quality.
• Join professional capability initiatives focused on defining career pathways, aligning skills with operational standards, and identifying targeted development needs.
• Lead or participate in internal mentoring programs to nurture technical growth and dispute resolution skills.
• Conduct in‑depth quality reviews of processed claims, especially large payouts, legally involved cases, or customer‑disputed files.
• Analyze potential errors or systemic risks within the claims workflow to propose preventive measures and strengthen operational controls.
• Establish technical evaluation criteria for Specialist and Senior Specialist levels to support periodic performance and quality audits.
• Contribute to the design of internal audit frameworks for Claims, ensuring focus on material risks, transparency, and operational realism.
• Collaborate with IT and system development teams to enhance technical tools such as claims dashboards, fraud behavior detection, and automated high‑risk triage.
• Provide technical input during workflow redesign sessions to assess legal compliance, operational feasibility, and policy alignment.
• Guide the integration of APIs with medical authorities, legal systems, or reinsurers to accelerate verification and improve data accuracy.
• Monitor enterprise‑wide performance indicators including complaint rates, average resolution time, and first‑pass approval ratios to identify bottlenecks and inter‑team disparities.
• Recommend multi‑variable triage models (complexity, legal sensitivity, product type, geographic region) for restructuring claim handling protocols.
• Participate in customer experience improvement initiatives within the claims process, covering feedback interface, communication style, update mechanisms, and post‑resolution sentiment analysis.
• Act as primary liaison with external auditors and reinsurers during claims case reviews; prepare professional justification, data analysis, and supporting documentation.
• Propose tailored quality control guidelines by benefit category and insurance product to support internal training and workflow standardization.

Yêu cầu công việc

• Bachelor's degree in Insurance, Finance, Economics, Business Administration or a related field.
• Minimum of 8 years of experience in claims processing, preferably in life insurance or large financial institutions.
• Strong understanding of claims procedures, life insurance product lines, and relevant legal frameworks.
• Proficient in reviewing and analyzing medical records, insurance policies, and accompanying legal documents.
• Effective internal and customer communication skills, with agile problem‑solving and adherence to transparency standards.

Mức lương

• Thỏa thuận

Thông tin khác

• Location: Hà Nội, Vietnam.
• Direct Manager: Manager/Senior Manager/Senior Expert, Claims Handling.
• Direct Reports: None specified.
• Internal Stakeholders: Internal function Division in company.
• External Stakeholders: Policyholders/beneficiaries, insurance agents, medical assessors, and legal documentation providers.