Medical Claims Team Lead
Sydney, NSW, Australia
Posted on Wednesday, December 6, 2023
Cover Genius is a Series D insurtech that protects the global customers of the world’s largest digital companies including Booking Holdings, owner of Priceline, Kayak and Booking.com, Intuit, Uber, Hopper, Ryanair, Turkish Airlines, Descartes ShipRush, Zip and SeatGeek. We’re also available at Amazon, Flipkart, eBay, Wayfair and SE Asia’s largest company, Shopee. Our partners integrate with XCover, our award-winning insurance distribution platform, to embed protection for millions of customers worldwide each year.
Our team and products have been recognized with dozens of awards including by the Financial Times which ranked Cover Genius as the #1 fastest-growing company in APAC in 2020. Our diverse team across 20+ countries and many language groups commit itself to diverse cultural programs, in particular “CG Gives” which makes social entrepreneurs out of us all and funds development initiatives in global communities.
Our People are
Bold, Authentic, Purposeful and Inspired
Our People are not
Perfect, Traditional, Complacent or Cautious
As a Medical Claims Team Lead at Cover Genius, you will take the lead in managing a team of assessors and oversee the efficient resolution of all travel claims including medical claims, emergency and assistance cases. Your main responsibility will be to ensure that claims are processed promptly and accurately, resulting in best in class claims experience and high levels of customer satisfaction . Your focus in this role will be on optimizing customer satisfaction by ensuring smooth claims processing and providing leadership to your team.
- Drive the development and execution of a world-class claims adjudication process, ensuring accuracy, efficiency, and compliance with industry standards.
- Create and implement innovative cost containment strategies to control claims-related expenses, negotiating favorable reimbursement rates with healthcare providers.
- Define and consistently meet or exceed performance targets tied to claims processing speed, accuracy, and cost reduction, contributing directly to the company's bottom line and customer satisfaction.
- Foster partnerships with third-party vendors and healthcare providers to improve claims processing efficiency and reduce turnaround times.
- Assist policyholders in understanding their insurance coverage. Explain claim procedures to policyholders. Provide guidance on required documentation. Resolve escalated and complex claims issues promptly and professionally. Handle escalated customer inquiries with empathy and professionalism.
- Drive a culture of continuous improvement within the claims department, identifying and implementing automation and process enhancements to optimize operations and resource allocation.
- Manage a team of 2-4 Claims Specialists, leading functional training and career development
- Document of all aspects of Claims Management, including a library of templates and SOPs
What you will bring
- Min. 5 years of experience in medical claims administration or customer service manager with medical claims experience
- In-depth knowledge of healthcare regulations, including HIPAA and other relevant privacy and compliance standards
- Strong knowledge of insurance claims processes and best practices
- Exceptional written and verbal communication skills, with the ability to communicate complex insurance and claims concepts clearly and effectively to both internal and external stakeholders
- Proven experience in a leadership or managerial role within an insurance claims department
- Commitment to delivering outstanding customer service
- Bachelor's degree in a relevant field, postgraduate degree and/or record of academic achievement is also desirable
Proficiencies and attributes
- Problem solving
- Strong customer focus and empathy
- Driven, energetic, positive approach
- Organizational and time management skills
- Excellent attention to details
- Professional approach and confident manner
- Ability to adapt quickly to a start-up pace environment and culture