Personal Accident & Travel Claims Supervisor

Ciudad de México
Permanente
Tiempo completo

Hace 2 meses

Personal Accident & Travel Claims Medical SupervisorWho we areAmerican International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and services that help businesses and individuals protect their assets and manage risks.We’re also committed to making a positive difference for our colleagues and in the communities where we work and live. We encourage colleagues to give back to the causes they care most about, supporting these efforts through our Volunteer Time Off and Matching Grants Programs.Get to know the businessGeneral Insurance is a leading provider of insurance products and services for commercial and personal insurance customers. It includes one of the world’s most far-reaching property casualty networks. General Insurance offers a broad range of products to customers through a diversified, multichannel distribution network.The claims function is meant to be a partner to the business segments, offering support, expertise and partnership. The existing diversity of the business portfolio demands from the claims role specialized expertise in the different business areas. The A&H claims team works with the business to support a wide array of products and offerings, through a complex and highly demanding distribution force and network. Claims has the responsibility of delivering and materializing the product offer and promise. In the case of A&H this opportunity is given in even the most sensible and highly complex situations where the health and well being of our insureds and clients is touched and where we can make a significant difference at that level.About the roleWhat you need to know:Medical examiner and supervisor of personal accident and serious illness claims, responsible for medical and surgical authorizations, as well as supervision of the operational management of business lines with technical opinion, with participation and medical opinion in reconsiderations of health claims and medical auditor in medical care based on injury diagnosis.Your contribution at AIGThe employee will be in charge of supervising and issuing medical advice on personal accident and health coverage for Serious Illness coverage with an approximate claims volume of 200 cases.Duties and Responsibilities1. Functional Responsibilities:Provide follow-up and solutions to claims requests received from insured parties and medical units regarding medical and surgical care for accidents, as well as attention to claims for compensation for serious illnesses.Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate for high value complex claims such as cancer, muscular dystrophy, sclerosis, heart attacks, strokes, as well as highly specialized surgeries based on the organization's best practices.Ensure effective management of healthcare providers and litigation within a personal mission, including demonstrable savings such as management of important medical trendsReporting key claims messages to their Team Manager and to internal stakeholdersBroader internal / external stakeholder communication where required, as (LoB) technical claims expert and thought leaderDelivery of technical training to colleagues and external contacts as appropriateAssist in continuous improvement across the region through support for the Quality Assurance / Regional Audit processes (potentially assisting Team Manager to complete monthly quality assurance reviews?)Ensure adherence to best practice procedures for (LoB) Complex claims, consistent with global best practice.Handle higher level of complexity claims Complex losses within authority limits2. Accountabilities:Key contact for resolving claims requests received from insured persons and medical units relating to medical and surgical care for accidents, as well as handling claims for compensation for serious illnesses.Timely, accurate and customer focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expenseEffective communication and management of key advanced Complex claims and (LoB) portfolio messages to internal stakeholders and customers/clients.Financial control through consistent reserve and other financial transaction disciplineAccurate and consistent policy interpretation.Medical audits of our provider network3. Leadership SkillsProfessional with a high sense of urgency, conflict resolution, empathy and high communication skillsExcellent communication skills, both written & verbalGood presentation skills and medical file knowledgeTime management – ability to manage & prioritize workload and diary managementAbility to contribute effectively within a team environment and with internal/external stakeholders at all levelsAbility to assist with technical medical training to team claim handlers as requiredAbility to influence claims and non-claims stakeholders to effectively direct claims strategy4. Technical Skills and ExpertiseKnowledge of general medicineKnowledge in the preparation and reading of medical reports and interpretationsExpert in identifying injuries and/or degenerative diseasesExperience and knowledge in personal accident and health claims.Policy language skills enabling accurate and consistent policy wording interpretation.A advanced and thorough knowledge of legal / regulatory and litigation / procedural requirements for their line of businessExperience in negotiation, mediation and arbitration, on complex claimsExperience in effectively following up on recommendations from technical claims audits and continuous file handling improvementWhat we’re looking for:

Experience:

Bachelor of Medicine
At least 3 years of claims handling or case management for medical or personal accident claims portfolio
At least 2 years of handling and managing medical service providers networks, cost containment strategies and continuous improvement strategies.
Medium to advanced policy wording interpretation and claims resolution on personal accident or medical expenses policies.
People management experience is not required but is a plus.
Proven experience in the handling of complex case management (e.g. cancer, muscular dystrophy, sclerosis, heart attacks, strokes, as well as highly specialized etc.).
Along with technical skills required for the job, soft skills like effective broker engagement, teamwork, proactive claims management, effective time management/priorization, calendar organization.
Effective analytical and attention to detail.

Ready to accelerate your career? We would love to hear from you.At AIG, we value in-person collaboration as a vital part of our culture, which is why we ask our team members to be primarily in the office. This approach helps us work together effectively and create a supportive, connected environment for our team and clients alike.Enjoy benefits that take care of what mattersAt AIG, our people are our greatest asset. We know how important it is to protect and invest in what’s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security—as well as your professional development—to bring peace of mind to you and your family.Reimagining insurance to make a bigger difference to the worldAmerican International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world’s most far-reaching property casualty networks. It is an exciting time to join us — across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.Welcome to a culture of inclusionWe’re committed to creating a culture that truly respects and celebrates each other’s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The talent of our people is one of AIG’s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to .Functional Area: CL - ClaimsAIG SEGUROS MEXICO S.A. DE C.V.

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