Assessor- Investigator, Claims

Department: Claims, Client Services
Reporting Manager Title: Head of Claims

Job Purpose:
- Reviews claim cases to determine validity and verification of coverage.
- Appraises and approves benefit claims within prescribed approval limits
- Be able to provide the response to inquiries and complaints related to claims from claimants, advisors, other departments.

Major Accountabilities:
1. Review claim cases and require for further information (from the clients or investigation) if necessary.
2. Assess and give claim decision within approval limit
3. Seek higher level’s decision for the cases that are over approval limit or complicated
4. Doing investigate in the claim cases need investigation.
5. Co-operate with Accountant for payment claim benefit as soon as possible
6. Co-operate with Legal depart. for seeking advice for complex cases that could lead to litigation
7. Co-operate with Compliance department for the fraud cases or suspected cases
8. Handle complaints and respond enquiries that related to claims from clients, advisor, other departments.
9. Other tasks assigned by manager and leader.
10. Support Sale force when necessary.

Performance Indicators (if necessary)
Finance Metrics (If relevant, describe type and amount (e.g. size of budget managed, revenue, etc.)
Sales Metrics (If relevant, describe type and amount.)

Specialized Knowledge/Skills:
Knowledge
1. Basics of life insurance and insurance company operations.
2. Individual life, group life and riders - contract provisions.
3. Logical thinking.
4. Communication skills.
5. Work in an organized manner
6. Ability and willingness to learn and adapt to the working environment
7. Provisions of the Insurance Code of Vietnam, and other regulations related to claims
8. Claim Assessment, Legal Aspects of Claims
9. Systems – ING/eBao

Skills/Competencies
1. Good Collaboration/Communication skills
2. Good presentation/negotiation skills
3. Thinks and acts strategically

Development/Training to support Role Competencies
1. LOMA (280,290)
2. ICA is preferred

Education and Experience:
- University graduated
- 3 years of experience with 2 years in Claims Assessment, Investigation, or Policy Services or Operations Process Management of Life Insurance Operations.
- Having Medical/Investigator/Low background will be preferred

- Attractive Salary
- Insurance according to company policy
- Dynamic and friendly working environment

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