Reconciliation DB Claims Manager

Job purpose:

The Reconciliation DB Claims Manager is responsible for overseeing and managing the Reconciliation process within the organization. To ensure that financial transactions and records are accurate and consistent, and that any discrepancies are identified and resolved in timely manner.

Key Responsibilities

• Reconciliation review process: The Reconciliation DB Claims Manager is responsible for establishing standardized reconciliation review procedures and guidelines. Ensuring that reconciliation files from providers are received, logged, and maintained. These files will have to be reviewed by the team following the defined processes and summarized as per the agreed format within the stipulated timeframes.
• Claims Administration activities: The Reconciliation DB Claims Manager is responsible for the claim administration activities of claim registration / upload into the system, ensuring all posted regulatory claims are available for processing, and the management of the remittance advice upload process.
• Team Leadership: Supervise and provide guidance to the claims reconciliation team. Ensuring that they understand their goals, responsibilities, and perform their tasks accurately and efficiently.
• Continuous Process Improvement: The Reconciliation DB Claims Manager is responsible for driving continuous improvement initiatives within the reconciliation unit. Continuously evaluate the reconciliation process and identify areas for improvement. Implement enhancements to streamlines processes, automate repetitive tasks, and reduce the risk of errors or gaps.
• Discrepancies Identification and Resolution: Identify discrepancies during the reconciliation process and investigate their causes. Take appropriate actions to resolve discrepancies, which may involve collaborating with other departments and stakeholders.
• Reporting: Prepare regular reports on the reconciliation activities, including outstanding items, aging analysis, and resolution status. Present these reports to the Senior management highlighting significant issues or trends.
• Compliance and Audit: Ensure that the reconciliation process sticks to industry regulations, internal control standards, and audit requirements. Collaborate with internal and external auditors during audits and provide necessary documentation and explanations.
• Stakeholder Management: Cooperate with various stakeholders, such as finance, underwriting, claims, external providers. Ensuring smooth reconciliation processes and resolve any issue or dispute in a timely manner.
• Continuous Monitoring: Continuously monitor the reconciliation process, track the KPIs of the reconciliation unit, and implement proactive measures to maintain accuracy and efficiency of the reconciliation unit.
• Exception Handling: During the reconciliation process, exceptions or discrepancies may arise. The Reconciliation DB Claims Manager is responsible for defining the protocols and escalation procedures for handling these exceptions. Coordinate with relevant stakeholders to resolve exceptions promptly and ensure that appropriate actions are taken to prevent similar issues in the future.