Claims Officer

Job Accountabilities

• To ensure claims procedures, documentation is adhered to the group claims management requirement and best practice
• To take proactive approach in monitoring employees’ compensation claims in order to minimize claims settlement
• To conduct in-house global settlement or be able to guide team to conduct in-house global settlement
• To build up relationship with all stakeholders and achieve compromised settlement to conclude the case at the earliest time and avoid litigation
• To meet with clients for claims review meeting
• To work with our healthcare specialist in minimizing claims duration
• To report to claims management team on adverse trend of development of claims
• To report to claims management team for clients with adverse claims experience
• To assist Claims Manager to monitor and conduct assessment of the performance of external loss adjuster whose services form part of claims services
• To provide quality customer service to clients
• To ensure all claims are processed effectively according to the company policies
• To set and monitor reserve adequately and timely and ensure the authoritative level laid down are complied with
• To identify all potential recovery and fraud cases
• To perform any other duties, task-oriented or claims related as may be delegated by Claims Manager
• Handle WC litigated claims taking responsibility to resolve all enquiries from both customer and external contacts to ensure delivery of a focused claims service.
• To develop a claim case strategy to ensure appropriate reserves are assigned, investigations conducted, and appropriate suppliers engaged.
• Acquire and efficiently organize the relevant evidence and information to accurately assess the value of the litigated claim and to recognize potential fraud/recovery indicators.
• Review, resolve and proactively finalize claims within authority limits ensuring settlement at an optimum level.

Job Qualifications

• Degree holder
• Tertiary education in one of the fields (or more) would be required:
  • Health, Insurance, Business Administration or Legal
• ANZIIF/ACII would be an asset
• Over 2 years EC claims management experience is a must
• Experience in managing legal claims is highly preferred
• Previous experience in handling corporate clients would be an asset
• Knowledge in insurance principles
• Litigation knowledge is highly preferred
• Understand legislation and legal liability
• Interpretation of policy cover
• Understand industry standards and protocol
• Knowledge of claims agreements
• Knowledge of the legal procedure of EC litigated case in Hong Kong
• With medical knowledge would be an asset
• Strong knowledge of Employees‘ Compensation Ordinance
• Global settlement experience
• Good command of written and spoken English & Chinese (including Mandarin and/or Cantonese)
• Negotiation skills, both written and verbal

Job Accountabilities

• To ensure claims procedures, documentation is adhered to the group claims management requirement and best practice
• To take proactive approach in monitoring employees’ compensation claims in order to minimize claims settlement
• To conduct in-house global settlement or be able to guide team to conduct in-house global settlement
• To build up relationship with all stakeholders and achieve compromised settlement to conclude the case at the earliest time and avoid litigation
• To meet with clients for claims review meeting
• To work with our healthcare specialist in minimizing claims duration
• To report to claims management team on adverse trend of development of claims
• To report to claims management team for clients with adverse claims experience
• To assist Claims Manager to monitor and conduct assessment of the performance of external loss adjuster whose services form part of claims services
• To provide quality customer service to clients
• To ensure all claims are processed effectively according to the company policies
• To set and monitor reserve adequately and timely and ensure the authoritative level laid down are complied with
• To identify all potential recovery and fraud cases
• To perform any other duties, task-oriented or claims related as may be delegated by Claims Manager
• Handle WC litigated claims taking responsibility to resolve all enquiries from both customer and external contacts to ensure delivery of a focused claims service.
• To develop a claim case strategy to ensure appropriate reserves are assigned, investigations conducted, and appropriate suppliers engaged.
• Acquire and efficiently organize the relevant evidence and information to accurately assess the value of the litigated claim and to recognize potential fraud/recovery indicators.
• Review, resolve and proactively finalize claims within authority limits ensuring settlement at an optimum level.

Job Qualifications

• Degree holder
• Tertiary education in one of the fields (or more) would be required:
  • Health, Insurance, Business Administration or Legal
• ANZIIF/ACII would be an asset
• Over 2 years EC claims management experience is a must
• Experience in managing legal claims is highly preferred
• Previous experience in handling corporate clients would be an asset
• Knowledge in insurance principles
• Litigation knowledge is highly preferred
• Understand legislation and legal liability
• Interpretation of policy cover
• Understand industry standards and protocol
• Knowledge of claims agreements
• Knowledge of the legal procedure of EC litigated case in Hong Kong
• With medical knowledge would be an asset
• Strong knowledge of Employees‘ Compensation Ordinance
• Global settlement experience
• Good command of written and spoken English & Chinese (including Mandarin and/or Cantonese)
• Negotiation skills, both written and verbal