Health Claim Operation Analyst

Job Summary
To handle single and multi-party personal or commercial line claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.
Job Qualifications
Required:

• Having good understanding with health insurance policy contract
• Bachelor’s Degree of Medicine, preferably with a medical degree
• Have experience 1 - 2 years in health insurance or health service provider (hospital/clinic)
• Good communication and personal skill
• Having good clinical analysis, pharmacology

Preferred:

• Ability to gather unique perspectives from other teams/functions to optimize outcomes.
• Ability to determine the scope and exposure for complex claims
• Strong multi-tasking and prioritization skills
• Understands, analyzes, and applies the component parts of an insurance policy for complex claims
• Effective verbal and written communication skills
• Ability to leverage trend and relationships to provide high-quality customer service
• Proactively shares and promotes sharing of insights
• Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
• Experience collaborating in a team environment and building cross functional working relationships
• Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
• Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies
• Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims

Job Accountabilities - Key Accountabilities

• Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
• Meet quality standards by following best practices
• Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
• Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.

A future with Zurich
Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 148 years of experience managing risk and supporting resilience. We are a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. Today, we serve more than 25 industries, from agriculture to technology and insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, Zurich strives to provide ongoing career development opportunities and foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our people, our customers and the communities we serve.
As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich is committed to providing a diverse, inclusive and barrier-free environment resulting in an accessible organization for employees, customers, and other parties who interact with, or on behalf of, Zurich. We strive to achieve a workplace free of discrimination of all forms, including discrimination on the basis of physical or mental disability, or medical condition. If you are interested in a job opportunity, please advise if you require an accommodation, so we can work with you to provide a more accessible process.
Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich Canadian Holdings Limited. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.
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