Description du poste

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
  
  

Complément

Partner Management:
To provide customer service support for the business portfolios according to SLA
Travel on Operational visits to partners with Team Leader/ Operations Manager ensuring prior organization by means of Agenda and Minutes to be circulated on return
Liaise with all partners in order to provide follow-up trainings and clarification on operational queries, understanding of policy wording and/or working processes via conference calls or emails
Relationship building and ongoing management is a large part of this role

Projects:
Participate in any projects related to your market including but not limited to – new product implementation and ongoing administering, new partnership implementation and ongoing administering
Training related to day-to-day business, training of new partnerships, new product training internally within the team/department or within the partnerships
Suggest ideas for continuous improvement to Team Leader and Manager

Interface:
Insurance Division: Dublin Management Team and Insurance Division in France (Administration, Business Development and other services)
Group: Group claims & subscriptions departments
External: Partners in Europe: Finance Companies & TPA