Senior Health Claims Manager

hace 4 semanas

Madrid, España AMG Human Consulting A tiempo completo

**Información del empleo**:
Sector

**Seguros**
***

Experiência laboral

**+5 años**
***

Ciudad

**Madrid**
***

Estado/provincia

**Madrid**
***

**Spain**
***

Código postal

**28001**

**Descripción del empleo**:
The
**Senior Health Claims Manager** initiates and conducts the health claims activities, together with specific entities, including all aspects like strategic vision, technical excellence and claims initiatives, transformation and process improvements, tool and vendor selection, insurance procurement, monitoring of activities, sharing best practices, sharing anti-fraud actions, building up claims’ analytics capabilities and alignment with other functions locally and at entities level.

**Requisitos**:
**Under the Head of Claims supervision the Senior Health Claims manager will**:
***
- Provide to all the entities timely and accurate service for claims transformation, initiatives and claims analytics. Share and support technical excellence and customer experience activities and selective involvement in entities’ claims initiatives (data analytics, FWA, medical providers management, ease customer service etc.), and fostering to link initiatives to measurable P&L impact
- Develops the definition of working priorities together with local entities. Build relationships with local heads of Health Claims, as an international expert. Travel to entities will be necessary as well as the ongoing remote interactions with the local teams and stakeholders.
- Assess capabilities, approaches and processes in the entities and help to design and implement action plans to improve along those dimensions.
- Strengthen the Claims community within the entities to share experiences, approaches, and knowledge (best practices). Building up the Claims Community at them, and liaise with other stakeholders in the group.
- Monitor key KPIs that indicate claims performance and engage in performance dialogue with local Claims Teams. Drive improved claims performance of the entities through a relevant and not heavy monitoring approach (from top-down to the details), which is seen as value add by Head of Claims in entities
- Set up, within the major entities, a case/disease management programme around high
- costs claims related to major chronic diseases
- Develop and improve quality checking tools, processes and reporting within entities in order to reduce leakage and FWA
- Support and perform Group In-depth reviews of entities or regional reviews, and support and follow up on review action plan and recommendations.
- Involvement in customer experience and technical Claims transformation projects in selected entities (e.g., implementation of new claims system, process redesign) resulting in improved NPS scores and lower average claims costs. Support entities on NPS measures to drive continuous improvement in the claims experience.
- Exchange regularly about Health Claims with the Line of Business (claims/ operations expert). Promotion of cross-functional collaboration between (at least) Claims, Pricing/ Underwriting and Reserving
- Interface to Group Insurance Office Claims and contribute to their initiatives and working groups (where relevant for the entities). Liaise with other stakeholders in the Group. Ensure entities’ compliance to Group standards and Solvency II Policies in Claims, participating in AMIH certification process.
- Involvement in Sophistication / Improvement of IT systems to improve data availability, automation as well as data quality

**Background and experience**
***
- 8 Years + Experience in Health insurance business.
- Currently working at minimum senior level.
- Working experience in Claims and/or fraud detection, and involvement in operations, finance & controlling, product, pricing, underwriting and reserving.
- Experience of delivering customer experience improvements in the claims process.
- Some international experience of different cultures and working practices preferable.
- Technical skills
- Fluent in Spoken & Written English (Spanish and French will be appreciated)
- Deep knowledge in claims management, processes, and tools
- Ability to interpret claims and financial information
- Broad knowledge of claims tool providers and their tools will be appreciated
- Soft skills
- Prioritisation and organisation skills
- Critical thinking
- Strong communication skills, resilient, persistent and highly target-oriented
- Strong skills to manage complex projects (multiple countries, several stakeholders)
- Strong customer first competencies and mindset
- Ability to network, establish relationships, and gain credibility from more senior roles, good ability to interact with interlocutors of cross-function teams and various levels of seniority
- Ability to adapt in a changing environment
- Team player and team builder
- Autonomous and results-oriented
- Capacity to influence in entities decision making

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