Key responsibilities / what you do:

Evaluate medical approvals and policy applications.

Guide medical claims officers in managing complex medical cases, enhancing both quality and productivity.

Maintain meticulous attention to detail and quality, leveraging AI analytics to ensure consistency and precision.

Offer second opinions on cases with uncertain treatment plans.

Review high-cost claims, make informed decisions on complicated cases, and communicate sensitively with the precertification and other departments, upholding confidentiality while using AI tools to support communication.

Provide clear, constructive feedback to the call centre team.

Explain declined medical claims to clients with clarity.

Handle routine daily claims administration efficiently.

Coordinate workflow to meet deadlines.

Deliver on-the-job training to team members as needed.

AI readiness

Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

Key requirements / what you bring:

Bachelor’s degree in pharmacy.

Practical medical experience with a reputable insurance provider, broker, or TPA is advantageous; entry-level candidates are also considered.

Strong verbal and written communication skills.

Flexibility and excellent interpersonal abilities.

A collaborative team player.

Keen attention to detail and commitment to quality.

Ability to work effectively with all levels of internal management, staff, and external clients.

Competence in training other staff members.

Skilled in communicating sensitively and effectively with the precertification and other departments, respecting strict confidentiality requirements.

Use AI insights to enhance collaboration and teamwork.

Initiative-driven, able to work flexibly under pressure and meet tight deadlines.