- Review claims processed by TPAs
- Oversee, review and approve approvals above a certain threshold
- Oversee case management conducted by TPAs
- Conduct fraud, waste and abuse for customers and liaise with TPAs to align company findings with TPA findings and execute corrective actions
- Oversee SLAs adherence and performance of TPAs
- Oversee and manage financial transactions between TPAs
- Day to day communications with TPAs and internal departments
- Life claims
- Review incoming life claims
- Communicate with claims beneficiaries and banks to complete claims documents
- Conduct claims investigations through external party to validate claims findings
- Adjudicate and validate life claims for payment or rejection
- Communicate with RI to apply RI guidelines in assessment and payment
- Communicate claims results with related parties
- Support legal department in fulfilling requirements for law suites
- Sanction screening:
- Perform regular sanction screening for reimbursement claims
Holding bachelor’s in pharmaceutical sciences/medicineExcellent communication, presentation and team working skillsStrong analytical and decision-making skills