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Operations Executive ? France M/F
- 19 mars
- Ireland
- CDI
Duties and responsibilities
To efficiently investigate and process claims, and administer the validation of medical subscriptions, implementing streamlined processes and procedures and provide business support on all operational aspects within your team and your department.
Claims:
Assess and process claims within the PPI portfolio according to relevant policy terms and conditions
Process and decision claims over the delegation for all businesses based on recommendation received from TPA and according to the relevant policy terms and conditions.
Confirm approval to TPA
Provide customer service for inbound and outbound calls
Check monthly reporting per partner for its accuracy and completeness
Check Claims transfer request forms and sign off monthly/weekly confirming accuracy
Propose process improvements to the processing investigation and settlement of claims
Report on productivity to Team Leader/Manager
Provide business support where required in Operations area
Maintain an individual internal quality level > 95% on a monthly basis
Medical Subscriptions (if applicable):
To administer subscriptions input and validation following recommendation from medical underwriters
To ensure proper communication between the team staff in the Dublin office, the local TPAs, and medical underwriters to ensure timely decisions are communicated to the partners following service standards
Complaints management back up (if Applicable):
To assist in the management and reporting of Complaints when complaints analyst is out of the office or if needed
To ensure and follow the complaints procedure associated
Business Support:
Assist in creating and updating claims, subscriptions procedures as and when necessary, for new and existing business
Assist the Team Leader in ensuring that all business documentation for the department is up to date, filed and archived
Present suggestions for reviewing and updating procedures to Team Leader and implement, coordinate, and monitor any upgrades to procedures as they are signed off
Provide training both internal & external
Maintain various regular and ad hoc reports and provide to your Team Leader
Perform other work or projects as and when selected by the Team Leader or Operations Manager
Experience in Claims handling, Medical U/W would be an advantage
Any relevant qualification including degree or insurance qualification would be an advantage
To efficiently investigate and process claims, and administer the validation of medical subscriptions, implementing streamlined processes and procedures and provide business support on all operational aspects within your team and your department.
Claims:
Assess and process claims within the PPI portfolio according to relevant policy terms and conditions
Process and decision claims over the delegation for all businesses based on recommendation received from TPA and according to the relevant policy terms and conditions.
Confirm approval to TPA
Provide customer service for inbound and outbound calls
Check monthly reporting per partner for its accuracy and completeness
Check Claims transfer request forms and sign off monthly/weekly confirming accuracy
Propose process improvements to the processing investigation and settlement of claims
Report on productivity to Team Leader/Manager
Provide business support where required in Operations area
Maintain an individual internal quality level > 95% on a monthly basis
Medical Subscriptions (if applicable):
To administer subscriptions input and validation following recommendation from medical underwriters
To ensure proper communication between the team staff in the Dublin office, the local TPAs, and medical underwriters to ensure timely decisions are communicated to the partners following service standards
Complaints management back up (if Applicable):
To assist in the management and reporting of Complaints when complaints analyst is out of the office or if needed
To ensure and follow the complaints procedure associated
Business Support:
Assist in creating and updating claims, subscriptions procedures as and when necessary, for new and existing business
Assist the Team Leader in ensuring that all business documentation for the department is up to date, filed and archived
Present suggestions for reviewing and updating procedures to Team Leader and implement, coordinate, and monitor any upgrades to procedures as they are signed off
Provide training both internal & external
Maintain various regular and ad hoc reports and provide to your Team Leader
Perform other work or projects as and when selected by the Team Leader or Operations Manager
Experience in Claims handling, Medical U/W would be an advantage
Any relevant qualification including degree or insurance qualification would be an advantage
