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Claims Support, Medical Admin

84637

Job Summary

Investigate, evaluate and conclude low exposure, low complexity personal or commercial line claims by following established protocols to ensure that claims are handled in the most effective, efficient way while delivering a customer-centric claims service.

Job Accountabilities - Key Accountabilities


• Capture and update claims data/information in compliance with best practices for low complexity, low exposure personal or commercial line claims.
• Determine liability by gathering relevant facts, utilizing applicable law and establishing basic principles of negligence.
• Confirm policy existence by identifying coverage on low complexity claims.
• Work to have a timely resolution to claims by developing case strategy, developing a case evaluation, escalating issues as appropriate and providing status updates to ensure customer satisfaction.
• Establish timely reserves within authority limit by estimating value of claims.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Ensure customer service by proactively communicating information, responding to inquiries and following customer protocols.
• Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Depart from approved vendors with manager approval, where in the best interests of the insured.
• Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
• Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
• Protect Zurich's reputation by keeping claims information confidential.
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks and participating in professional societies.
• Contribute to the team effort by accomplishing related results and participating on projects as needed.
• Follow established claims handling procedures for low complexity, low exposure personal or commercial line claims to ensure consistency and quality in claims services.
• Collect data and document in established system to facilitate the accurate assessment and value of claims.
• Input relevant data into established systems accurately so that analysis can be undertaken.
• Identify and resolve problems by referring to policies, procedures, and standards to ensure consistency and quality of solutions.
• Assess and appoint claims vendors within agreed authority limits aligned to the organization´s Claims Vendor Management strategy.
• Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and promote continuous learning.
• Provide feedback on business processes and systems to identify opportunities for improvements.

Job Functions


• May negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• May participate in customer marketing efforts.
• May contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.

Business Accountabilities


• Develop a practical understanding of how processes and systems in own area of work relate to the management of risk and compliance.
• Adhere to local regulatory and governance requirements throughout the life of a claim to ensure decisions are made using the right standards.
• Acquire and organize the relevant evidence and information to accurately assess the value of a claim.
• Provide feedback and recommendations for improvement of processes and systems.
• Respond to and resolve enquiries and problems, judging when to pass complex queries on to or involve others, to provide an effective service and clear advice to colleagues and customers.
• Respond to queries from customers and/or colleagues to ensure customers receive appropriate advice.

You are the heart & soul of Zurich! 
 

At Zurich, we like to think outside the box and challenge the status quo. We take an optimistic approach by focusing on the positives and constantly asking What can go right? 

We highly value the experience and know-how of our employees and offer a wide range of opportunities across business areas to encourage you to apply for new opportunities within Zurich when you are ready for your next career step. 

Let’s continue to grow together!

 

  • Location(s):  MY - Kuala Lumpur 
  • Remote working:
  • Schedule:
  • Recruiter name: Kaur Tarenjit
  • Closing date:

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