Head of Claims - 20000660
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Our opportunity
Directs and coordinates all Life Company claims activities related to life, disability, annuity, health, accelerated benefit and accidental death and dismemberment policies. Ensures prompt settlement of Life Company claims in accordance with the terms and conditions of each policy, and in conformity with applicable federal/state laws, regulations, policies, practices, industry standards and procedures. Plans, develops, recommends and implements claims procedures, techniques and methods for investigation, evaluation and disposition. Analyzes and interprets claims results and trends. Makes recommendations to improve service and overall claims handling.
- Your role
- • Supervises assigned personnel.
- • Directs Life Company claims activities both within and outside operating territory.
• Ensures prompt and accurate payment of legitimate claims.
• Authorizes payments and denials within established authority limits.
• Develops, evaluates, recommends and implements standards, practices, procedures and techniques for the investigation, evaluation and disposition of life, disability, annuity, health, accelerated benefit, and accidental death and dismemberment claims.
• Establishes and monitors operational controls to assure reinsurance claims processing requirements are met.
• Works with reinsurance company claims and management personnel to maintain sound, supportive relationships.
• Oversees the results of claims investigations, and counsels with the Life Claims Staff, Special Investigation Unit Manager, Legal Counsel and Officer in Charge as needed to ensure that investigations are conducted in accordance with applicable laws, regulations, standards and practices.
• Reviews claims recommended for denial, evaluates pertinent issues, consults with underwriting, medical department, law department, officer in charge and others as necessary to carry out appropriate action. Formulates final recommendation to officer in charge for cases outside of established authority limits.
• Analyzes and resolves disputes between the Life Company and claimants on coverage issues.
• Counsels with Life Company management and others as necessary. Recommends appropriate course of action.
• Communicates with company personnel, state executives, agency support, district managers, agents, policyholders, beneficiaries, legal representatives and state insurance departments.
• Serves as primary representative at settlement conferences, mediation hearings and trials as directed.
• Participates in public relations and professional association activities related to Life Company claims.
• Identifies and assesses impacts of legislative changes and judicial decisions on claims processing. Recommends and implements appropriate revisions in practices and procedures. Assures compliance with statutory and regulatory requirements in all states.
• Counsels with department heads on products, practices and procedures that impact claims administration. Makes appropriate recommendations.
• Develops, recommends and implements workload standards and claims authority levels to ensure efficient and effective claims processing.
• Oversees the compilation of claims data for use by management.
• Directs claims studies to identify causes of unfavorable trends and formulates recommendations for corrective action.
• Coordinates preparation, control and administration of Claims Department budget.
• Performs other duties as assigned.
Business Accountabilities
• Translate business objectives into clearly defined business cases, costs or schedules which work for a local market in order to support achievement of a work area.
• Lead the implementation of projects for a function or business area to deliver defined objectives with allocated resources and timescales.
• Monitor non-compliance issues escalated by other team members, or through wider relationships, and highlight patterns for senior members of the team to address.
• Analyze key themes from a wide range of data sources in order to determine exposure and financial impact of decisions upon the business.
• Contribute to the development of processes and lead the implementation of systems and process improvements in own area that work in local circumstances.
• Evaluate the most complex customer cases and develop bespoke technical solutions to enable the organization to meet its´ needs within policy constraints.
• Develop and manage ongoing relationships with key stakeholders/customers in order to keep them informed and ensure they are engaged so solutions benefit all parties.
• Analyze and present management reporting to senior managers to deliver transparency of claims performance against business goals, directing necessary actions for improvement.
• Direct organizational change decisions within claims area, directing change activity and engaging relevant stakeholders/service providers to meet the overall goals of a change program.
• Embed global best practice in specialist area within local market, providing feedback to deliver continuous improvement across the organization.
• Engage, influence and collaborate with claims vendors and potential claims vendors to secure optimal outcomes for the organization.
Your Skills and Experience
Bachelors degree (or equivalent) and 10 or more years of experience in related field
Who we are
Looking for a career that will excite, challenge and inspire you? Thinking about insurance? Perhaps you should. Working for us is a totally different experience to what you probably expect. How do you feel about the things you truly love? Don’t you want to protect them in the best way possible? Imagine if you could help people do this all over the world. You’d give them confidence and reassurance by protecting what they love most. This is no easy task. In today’s interconnected world, tackling risk is fast, unpredictable and invigorating. You’ll have to think on your feet as you manage risks big and small, from flooding to cyber crime. You’ll be tackling issues like these in over 170 countries. It’s a big challenge, but you’ll have a truly diverse network helping you. As part of an international team, every day would provide opportunities to learn, grow and share ideas.
As you make an impact across borders, you’ll feel the support of being part of a strong and stable company. A long-standing player in the insurance industry, we make every effort to address the career development needs and plans of our employees to ensure their success in the future.
So make a difference. Be challenged. Be inspired. Be supported, Love what you do. Work for us.
Zurich Insurance has the policy to be an equal opportunity employer. We aim to attract and retain the best qualified individuals available, without regard to criteria such as race/ethnicity, national origin, religion, gender, sexual orientation, age or disability.
At Zurich we believe that having a culture of inclusion is essential in delivering good results. Attracting, retaining and developing a diverse workforce where employees feel valued, respected and empowered allows people to reach their full potential. As a business this diversity helps us to better reflect and understand our 4 million customers’ needs to allow us to drive better outcomes. As a global organisation, with an increasingly agile workforce, we're happy to consider flexible working arrangements.
Primary Location
: Malaysia-Kuala Lumpur-Kuala Lumpur
Schedule
: Full-time
Travel
: No
Job Posting
: 11/02/20
