Location: 

Tel Aviv, TA, IL

 

Medical Operations Claims Specialist 

About Swiss Re

The Swiss Re Group is one of the world’s leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. It anticipates and manages risk – from natural catastrophes to climate change, from ageing populations to cybercrime. The aim of the Swiss Re Group is to enable society to thrive and progress, creating new opportunities and solutions for its clients. Headquartered in Zurich, Switzerland, where it was founded in 1863, the Swiss Re Group operates through a network of around 80 offices globally. It is organised into three Business Units, each with a distinct strategy and set of objectives contributing to the Group’s overall mission.

 

Objective of Role

To support Asia L&H Medical Operations team and the EMEA L&H Products teams in providing Medical Operations related advice and technical expertise in respect to product initiatives and strategy throughout Life & Health business of Swiss Re in EMEA.

 

Key Accountabilities

Clients:

  • To provide managed care consulting support to clients including areas such as network consulting and contracting, provider profiling, medical management programs, pharmaceutical management, and TPA selection and operations.
  • To support the Business Unit in new business tenders and in management of renewals of business, innovative product development and in promoting team profile, value proposition and expertise in EMEA markets
  • To create and maintain a positive relationship with senior management at clients (COOs, Product Development, Claims managers) to help SR manage our reinsured portfolio and to help us win new business.
  • To position SR as thought leader and influencer for claims management and medical operations in the markets in which we operate.

 

People:

  • To work closely with Client Markets to ensure best in class service to our Clients;
  • To collaborate with Costing and Underwriting team for portfolio data analysis and interpretation with appropriate feedback for future Product development, risk management strategies and Pricing as well as suggest appropriate interventions to improve the portfolio's overall experience.
  • To effectively bring and work on best practices which may be used in medical operations teams in other countries.
  • To assess the impact of any regulatory changes that may impact the business or the portfolio or product development and present the same to internal teams.

 

Operational Excellence:

  • To effectively manage SR claim liability through identifying and implementing appropriate client and claims management / risk management strategies within the terms and conditions of the policy and pricing assumptions.
  • To develop, articulate, and to maintain Swiss Re best practice and guidelines for product risk appetite, portfolio / provider / TPA / and operational infrastructure.
  • To ensure the data integrity of systems/databases for all claims adjudicated or assessed.
  • To assess and process claims using the Claims Manager tool in accordance with operating procedures as required.
  • To prepare and present analytics reports, best practices, portfolio benchmarking assessment etc. both internally and to clients on a pre-agreed frequency.

 

Key Skills & Knowledge

  • Excellent technical knowledge in claims management and medical management programs;
  • Auditing experience and reporting capabilities a must.
  • Experience with medical insurance product design and claims definitions, provider or TPA contracting
  • Ability to use sound Medical Operations knowledge in a commercial environment;
  • Fundamental understanding and knowledge of the EMEA insurance and reinsurance industry and knowledge of the main products and services offered by various insurance and reinsurance companies;
  • Excellent interpersonal, communication and influencing skills.
  • Organization, prioritization and planning skills;
  • Strong data analytical skills
  • Training and/or presentation skills and experience.

 

Candidate Requirements

  • Formal qualification in business, financial services, law, and/or health discipline;
  • 5 - 10 years of work experience in direct / reinsurance companies / TPA in EMEA; overseas experience a plus;
  • Significant prior experience with medical claims management;
  • Prior experience working with or for operations, underwriting, product development, and/or pricing team;
  • Excellent oral and written communication skills in English
  • Excellent interpersonal, communication and influencing skills;
  • Clinical background a plus, but not mandatory.

 

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, or disability status. 

 

 

 

 


Keywords:  
Reference Code: 85851 

 

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