Assistant Medical Care Case Manager

Job title: Assistant Medical Care Case Manager

Company: AXA Hong Kong and Macau


Job description: AXA Hong Kong and Macau is a member of the AXA Group, a leading global insurer with presence in 51 markets and serving 94 million customers worldwide. Our purpose is to act for human progress by protecting what matters.As one of the most diversified insurers in Hong Kong, we offer integrated solutions across Life, Health and General Insurance. We are the largest General Insurance provider and a major Health and Employee Benefits provider. Our aim is to not only be the insurer to provide comprehensive protection to our customers, but also a holistic partner to the individuals, businesses and community we serve. At the core of our service commitment is continuous product & service innovation and customer experience enrichment, which is achieved through actively listening to our customers’ needs and leveraging and investing in technology and digital transformation.We embrace our responsibility to be a driving force against climate change and a force for good to create shared value for our community. We are proud to be the first to address the importance of mental health through different products and services and thought leading iconic research. Our overall Sustainability Strategy, with emphasis on climate strategy and biodiversity commitment, is developed based on TCFD recommendations. We are committed to integrating environmental, social and governance factors across our business and strive to contribute to a sustainable future through 3 distinct roles – as an investor, an insurer and an exemplary company.Our people strategies are designed to enhance employee well-being and professional growth, ultimately empowering them to excel within the company.
Click here to learn more about our Benefits (https://www.axa.com.hk/en/benefits) , Culture (https://www.axa.com.hk/en/culture-and-values), & Career Development (https://www.axa.com.hk/en/career-development).About AXA Hong Kong and MacauAXA Hong Kong and Macau is a member of the AXA Group, a leading global insurer with presence in 51 markets and serving 94 million customers worldwide. Our purpose is to act for human progress by protecting what matters.As one of the most diversified insurers in Hong Kong, we offer integrated solutions across Life, Health and General Insurance. We are the largest General Insurance provider and a major Health and Employee Benefits provider. Our aim is to not only be the insurer to provide comprehensive protection to our customers, but also a holistic partner to the individuals, businesses and community we serve. At the core of our service commitment is continuous product & service innovation and customer experience enrichment, which is achieved through actively listening to our customers’ needs and leveraging and investing in technology and digital transformation.We embrace our responsibility to be a driving force against climate change and a force for good to create shared value for our community. We are proud to be the first to address the importance of mental health through different products and services and thought leading iconic research. Our overall Sustainability Strategy, with emphasis on climate strategy and biodiversity commitment, is developed based on TCFD recommendations. We are committed to integrating environmental, social and governance factors across our business and strive to contribute to a sustainable future through 3 distinct roles – as an investor, an insurer and an exemplary company.AXA is an equal opportunity employer. We are committed to promoting Diversity and Inclusion (D&I) by creating a work environment where all employees are treated with dignity, respect, and where individual differences are valued. We welcome and treasure diverse profiles to join our big family, and to build an inclusive culture together which allows everyone to maximise their personal potential.Our people strategies are designed to enhance employee well-being and professional growth, ultimately empowering them to excel within the company. Click here to learn more about our Benefits (https://www.axa.com.hk/en/benefits) , Culture (https://www.axa.com.hk/en/culture-and-values), & Career Development (https://www.axa.com.hk/en/career-development).Responsibilities:Medical Case Management

• Handle enquiries and help the members through various communication channels (Hotline, Email, Webchat, voice, fax, electronic including email and instant messaging) using the high level of customer service and nursing expertise
• Collaborate and liaise with relevant stakeholders (Hospital providers, specialists, internal counterparts and back office) to provide the high quality and cost-effective interventions and for members’ healthcare needs
• Handle case assignments, draft service plans, review case progress and determine case closure
• Contribute to achieve agreed SLAs and service standards

Audit and related matters

• Conduct claims audit for Life and Health claims (medical focus)
• Develop, refine and implement the AXA Claims Philosophy (Life & Health) together with the development of training and quality framework
• Formulate and review guidelines, conduct quality programs, develop training materials, monitor and measure trends/performance and conduct technical claims reviews

AEFI Fund support

• Coordinate and liaise with internal stakeholders to provide support to the Hong Kong Government for the subject matter
• Provide statistics and billing for the AEFI fund

Claims Research (Life & Health)

• Benchmarking of Claims capability & practices
• Review and analyse key Claims data to identify, profile, root causes of loss ratio deterioration, trends and issues in the portfolio and initiate appropriate feedback into product, underwriting and better claims management
• Provide proactive support to claims management team to assist in fraud detection, cost containment and training and development initiatives

Other responsibilities

• Assist Chief Medical Director to develop training program on medical knowledge to different stakeholders within corporate.
• Any other projects as assigned by the Chief Medical Officer

Qualifications:

• University graduate in healthcare discipline, preferably a registered nurse
• At least 3 years’ experience in customer services in healthcare or insurance industry. Candidates with less experience will be considered as Medical Care Senior Officer
• Proficient in both spoken & written English & Chinese, mandarin is an advantage
• Excellent communication & interpersonal skills
• Attentive to details and well-organized
• Customer oriented, Independent with problem solving skills
• Willing to learn and self-motivated
• Proficient in MS office, excel and powerpoint

Expected salary:

Location: Hong Kong

Job date: Sun, 26 Jan 2025 08:53:39 GMT

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