L&S and Health Claims Senior Technical Manager

Location 75-PARIS, France
Experience level Experienced Hire
Job details sector Legal and Compliance
Apply before Date not available

Group Insurance Office:

 

The role of GIO ensure and promote technical excellence within the AXA Group and for all business lines (P&C, L&S and Health):

  • Define the technical standards/guidelines for the Group
  • Ensure the implementation of the standards defined and conduct regular technical audits in the US, Europe and Asia
  • Contribute to the definition of the Group's strategic focus and contribute to the Process of Product Approval
  • In coordination with GRM, define the risk appetite for underwriting in order to enable the creation of long-term value for the Group's shareholders.
  • Define the framework and the limits of underwriting for both the operational entities and the markets in a logic of guided empowerment so as to ensure the effective implementation of such limits and intervene as a reference consultant for risks that go beyond the local underwriting framework
  • Contribute as much as necessary to the process of definition of the objectives and the business reviews
  • Centralize all the good practices identified and coordinated by the Markets and bring an outsider viewpoint to promote the implementation of good practices.
Group Claims in the GIO department:
 
The role of L&S and health Group Claims is to insure the role of the GIO relating to claims:
  • Define L&S and health claims standards and ensure they are implemented in all entities through regular technical audits (e.g. In-Depth Reviews, Technical Reviews, Internal Model Reviews).
  • Develop the L&S and health claims technical practices and culture together with local claims professional families.
    • Continue trainings and animation of communities with entities and markets
    • In conjunction with entities and markets, identify and centralize best practices and propagate through Technical Communities
    • Identify internal & external innovations
    • Develop expertise / tools
    • Ad-hoc support entities in executing technical initiatives
  • Contribute to the definition of Group’s strategic focus (incl. objectives definition process) and monitoring of the technical performance (incl. monthly business reviews)
  • Ensure technical excellence in process improvement / digitization / automation
  • Exchange best practices and tools if relevant with P&C claims team in particular on Fraud and CFR.

Mission:

 

The L&S and Health claims senior technical manager is accountable for supporting day to day activities, working on the Group Claims strategy for the technical excellence side and performing all operational leadership and strategic tasks linked to claims management within agreed timeframes to meet service standard targets.
  • Contribute to the development of the Claims Management Strategy of the Group in terms of theory and practices
  • Promote a visionary approach to claims assessment in line with corporate objectives and values
  • Contribute to In Depth Review on Life and savings and Health for claims side and specially for file by file review

The L&S and Health claims senior technical manager provides advice, shares technical expertise, training and guidance to the entities’ Claims teams in medical and non-medical aspects consistent with AXA Claims standards and philosophy. One of the core responsibilities is to lead the streamlining of the claims processes for low sum assured and non-complex claims. 

  • Manage and lead the effective claims management operations to insure technical excellence across entities including direction setting and strategy, it could be through IDR, technical reviews or others study
  • Manage and develop relationships with internal and external service providers/partners, including third party administrators, regulators, industry bodies, legal firms, medical professionals and reinsurers

The L&S and Health claims senior technical manager should work with the L&S and Health claims process and organization manager to ensure that the claims management processes are fully aligned to the Group claims philosophy in particular on the technical excellence side.

  • Contribute of the development, implementation and management of the claims philosophy, guidelines, and the risk & compliance framework, including compliance with all relevant laws and regulations
  • Make sure that current claims management philosophy leads to profitability across all product lines

The role requires working closely with UW Team to identify training opportunities and make recommendations to enhance technical excellence through various learning programs or platforms such as the “Train The Trainer” initiative, and on-site training workshops

  • Provide credible support and work closely with product development, product strategy, underwriting philosophy/guidelines, risk management and distribution initiatives across the business

To ensure mortality and profitability expectations are met, the L&S and Health senior claims technical manager leads the quarterly monitoring of Claims KPIs and review of local claims practices (as a representative of the Group Insurance Office).

  • Provide guidelines to the entities for all dispute resolution and litigated matters
  • Give second opinion on large and complex claims cases
  • Sourcing statistics and referring claims to CMO/Medical Officer where appropriate

 Activities: 

  • Provide day to day advice on all claims related topics
  • Contribute to the Claims Committee
  • Contribute to In Depth review and follow up of recommendation
  • Maintain relationship with the medical profession
  • Manage advice to the Protection team on claims issues
  • Maintain working knowledge of changing legislation that affects the use of risk profiling in claims management
  • Contribute to the definition of benefits in product development and revision
  • Provide advice to the product actuaries on likely impact of product design and claims management
  • Identify medical knowledge deficiencies and develop/coordinate the implementation of training or process changers 
  • Identify options, and advise the Protection Managers on addressing problems/opportunities
  • Provide technical input into the production of function-specific guidelines and training modules on medical (with the support of CMO/MO) and non-medical matters
  • Coordinate cross-functional effort to address medical matters
  • Represent AXA when appropriate
  • Maintain clear, organized and comprehensive claims records and documentation
  • Prepare informed and appropriate claims management communications and advice records

Experience and Qualification:

           
Qualifications:
  • Claims management background of 5 years
  • Insurance medicine knowledge desirable
  • Medical qualification desirable, but not mandatory
  • Ability to convert data /statistics into meaningful reports/conclusions

Knowledge: 

  • Understanding of Life Insurance and life insurance industry
  • Good understanding of underwriting and risk management principles
  • Understanding of protection/Life and health products
  • Understanding of the Insurance Contracts Act and other relevant acts
  • Comprehensive understanding of medical principles, standards and practices

Experience:  

  • At least 10 years of experience in protection business
  • Disability, Critical Illness and Total Permanent Disability claims management experience
  • Established network with life insurance specialists within AXA/outside AXA

Skills:

  • Understanding of the application of medicine in claims management
  • Demonstrated ability to provide and interpret reports

Broader skills /attributes: 

  • Research skills
  • Understanding of mortality/morbidity and disease incidence
  • Understanding of Claim & Underwriting standards, principles and best practices
  • Understanding of information requirements within relevant categories and functional units
  • Understanding of the broader industry and company issues
  • Demonstrate willingness and capacity to extend knowledge base in relevant areas and maintain professional development and to undertake projects


Would you like to wake up every day driven and inspired by our noble mission and to work together as one global team to empower people to live a better life? Here at AXA we strive to lead the transformation of our industry. We are looking for talented individuals who come from varied backgrounds, think differently and want to be part of this exciting transformation by challenging the status quo so we can push AXA - a leading global brand and one of the most innovative companies in our industry - onto even greater things.

In a fast-evolving world and with a presence in 64 countries, our 165,000 employees and exclusive distributors anticipate change to offer services and solutions tailored to the current and future needs of our 107 million customers.

 


The headquarters of the AXA Group, based in Paris 8th, brings together the Group's corporate activities. It coordinates the various entities with the Group's strategy, and is responsible for managing international projects. The headquarters has approximately 800 employees and is distinguished by its strong international culture (39 nationalities).

.