Key responsibilities include the following:
- Assess, negotiate, and settle WICA claims in accordance with policy terms and conditions, within delegated authority limits and prescribed timelines.
- Ensure claims handling complies with WICA regulations, internal policies, and stipulated timelines, while maintaining effective cost control through appropriate reserving and claims strategies.
- Review claim documentation, including medical reports, accident reports, and supporting documents, to determine liability and compensation.
- Liaise with service providers such as panel lawyers, Third Party Administrators (TPAs), and loss adjusters to ensure efficient and effective claims handling.
- Manage enquiries, feedback, and escalations from internal and external stakeholders in a timely and professional manner.
- Conduct monthly and ad-hoc claims reviews to ensure reserve adequacy and that claim files are accurate, complete, and up to date.
- Prepare and generate regular (monthly, quarterly) and ad-hoc claims reports for management and stakeholders.
- Track and monitor claims performance indicators, identifying trends, issues, and opportunities for improvement.
- Identify and pursue recovery opportunities for claims with subrogation or recovery potential.
- Mentor junior claims staff and provide training, coaching, and technical guidance as needed.
- Support the implementation of process improvements, automation initiatives, and system enhancements.
- Support training initiatives for both internal and external stakeholders where required.
- Undertake any other duties or projects as assigned by management.
Qualifications and Competencies
- Degree or Diploma in any discipline.
- Professional insurance certifications are required; BCP and ComGI qualifications are mandatory.
- Minimum of 3 to 5 years of relevant claims handling experience, preferably with strong exposure to WICA 2019 claims
- Strong communication, negotiation, and conflict resolution skills.
- Excellent analytical and problem-solving abilities, with a high level of attention to detail.
- Ability to work independently and effectively in a fast-paced environment while managing multiple priorities.
