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This role works closely with the CS Operations Managers to help keep the business operations running smoothly. Under the New Business Processing setting, he / she shall be responsible in all activities relating to new business requests and ensuring that all new businesses are properly recorded in the system.
He / she shall also facilitate evaluation and obtaining approvals of individual member beyond the No Evidence Limit (NEL).
He / she may also be assigned to helpdesk servicing specific to group medical accounts. Under the Policy Member and Administration setting, he / she shall be responsible in all activities relating to post new business servicing activities.
Under the Claims setting, he / she shall be responsible in the review of accuracy and completeness of the received claim forms and documents.
He / she also works closely with different work units to facilitate adjudication, approval and settlement of claims.
1. Observes the following line of authority :
a. Division Head : Corporate Solutions
b. Department Head : Corporate Solutions - Operations
Unit Head : Corporate Solutions Claims and Operational Efficiency
2. Main Functions
New Business Processing
Evaluates New Business Requests and requirements
Creates and maintains new account records in the system
Sets-up of policy and member records in the system
Allocates premium payments
Generates Initial Billing
Releases Policy Contracts and Initial Billing to Agents and / or Clients
Evaluates individual members beyond the New Evidence Limit (NEL) and facilitation of requirements and approvals thereof
Performs helpdesk servicing specific to group medical accounts
Policy and Member Administration
Evaluates policy changes and / or member movement requests and validates pertinent documentary requirements
Updates client / policy information in the system
Reconciles current and updated member records
Creates Policy Endorsements
Creates of Renewal Bills
Reconciles over / under premium payments in the system
Release Policy Endorsements, Renewal Bills and Certificates of Cover
Claims Receiving and releasing
Evaluates accuracy of claims and completeness of claims documents
Sends advice of lacking requirements to clients / agents / brokers (if applicable)
Registers received claims in the system
Coordinates adjudication / approval of claims to Life Operations - Claims
Facilitates release of claims checks / payments of all Home Office filed claims
Handles claims inquiries
3. Other Responsibilities
Performs other responsibilities and duties periodically assigned by supervisor in order to meet operational and / or other requirements
MINIMUM JOB REQUIREMENTS
Education Graduate of any 4 year College Course
Experience At least two (1) year experience in client servicing
Build a career with us as we help our customers and the community live healthier, longer, better lives.
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