Senior Health Claims Manager - Madrid, España - AMG Human Consulting

AMG Human Consulting

Empresa verificada

Madrid, España

hace 3 semanas

Publicado por:

Isabel García

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Descripción

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 topdown 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 Indepth 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 crossfunctional 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 targetoriented
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 crossfunction teams and various levels of seniority
Ability to adapt in a changing environment
Team player and team builder
Autonomous and resultsoriented
Capacity to influence in entities decision making

**Estoy interesado