Manager - Health Claims Processing

About the Job

We are looking for an experienced Claims Manager (Processing) to handle and deliver end-to-end assessment and processing of accident and health claims within the Regional Service Centre, ensuring accurate, timely, and compliant claims outcomes in accordance with delegated authority limit, service standards, and established procedures. 

You’ll play a vital role in ensuring our policyholders receive timely and accurate support when they need it most. You will also be given the opportunity to participate in continuous process improvement initiatives, enhancing overall claims experience. 

1. Claims Processing & Decision Making

• Assess and process Life & Health claims within delegated authority limit and established service standards, ensuring compliance with policy terms, claims guidelines, and SOPs.
• Ensure accurate benefit determination, correct payee details, reserve adequacy and timely claim settlement.
• Conduct review of pending claim to ensure closure of claims in a timely manner.
• Identify claim patterns and unusual or inappropriate practices and recommend improvements to strengthen claims controls and streamline claim processes.
• Identify and resolve processing issues, escalating out-of-scope complexity appropriately.
• Mentor and guide junior claim assessors. 

2. Stakeholder & Customer Engagement

• Engage with medical professionals, policyholders, claimants and agents to obtain necessary documentation, clarify information or outstanding requirements for claim evaluation.
• Provide timely updates and operational insights to internal stakeholders. 

3. Delivery of Service Excellence

• Provide clear, empathetic communication timely to policyholders, claimants and agents medical professionals, and internal stakeholders, making the claims process smooth and transparent. 

4. Process Standardization & Improvement

• Ensure standardisation of claims processing workflows across markets supported by the Regional Shared Centre.
• Identify opportunities to simplify processes, improve straight-through processing, and enhance efficiency. 

5. Ensure Governance, Risk & Compliance

• Adhere to internal policies and external regulatory requirements to maintain integrity and trust in our claims operations.
• Maintain strong operational controls to mitigate processing, financial, and compliance risks. Proactively identify operational and compliance risk areas and implement corrective actions.
• Support audits, quality assurance, and compliance reviews as required.
• Maintain proper documentation and audit trail for claims decisions.

We are looking for people who

• Holds a Bachelor’s degree or Professional Insurance Certificate or a related insurance or healthcare discipline.
• More than 8 years of life insurance claims experience, with strong hands-on exposure to claims processing.
• Strong grasp of medical practices, terminology, ICD/CPT codes, and insurance policy terms
• Strong analytical skills with ability to interpret complex medical data, spot trends, and make sound decisions under pressure.
• High attention to detail with strong decision-making discipline.
• Detail-oriented with a proven track record of managing high processing volumes without compromising quality.
• Are customer-focused and excellent at building relationships with stakeholders and delivering clear, empathetic communication.
• Experience supporting multiple markets is an advantage.
• Team players; are eager to learn and grow in a fast-paced, collaborative environment that values innovation and service excellence.

• Champion and embody our Core Values in everyday tasks and interactions.
• Demonstrate high level of integrity and accountability.
• Take initiative to drive improvements and embrace change.
• Take accountability of business and regulatory compliance risks, implementing measures to mitigate them effectively.
• Keep abreast with industry trends, regulatory compliance, and emerging threats and technologies to understand and highlight potential concerns/ risks to safeguard our company proactively.

Founded in 1908, Great Eastern is a well-established market leader and trusted brand in Singapore and Malaysia. With over S$100 billion in assets and more than 16 million policyholders, including 12.5 million from government schemes, it provides insurance solutions to customers through three successful distribution channels – a tied agency force, bancassurance, and financial advisory firm Great Eastern Financial Advisers. The Group also operates in Indonesia and Brunei. The Great Eastern Life Assurance Company Limited and Great Eastern General Insurance Limited have been assigned the financial strength and counterparty credit ratings of "AA-" by S&P Global Ratings since 2010, one of the highest among Asian life insurance companies. Great Eastern's asset management subsidiary, Lion Global Investors Limited, is one of the leading asset management companies in Southeast Asia. Great Eastern is a subsidiary of OCBC, the longest established Singapore bank, formed in 1932. It is the second largest financial services group in Southeast Asia by assets and one of the world’s most highly-rated banks, with an Aa1 rating from Moody’s and AA- by both Fitch and S&P. Recognised for its financial strength and stability, OCBC is consistently ranked among the World’s Top 50 Safest Banks by Global Finance and has been named Best Managed Bank in Singapore by The Asian Banker.

Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or our employees. We will not be responsible for any fees related to unsolicited resumes.