Claims Manager

Description

Job Description: **At AXA Mexico, we seek individuals who dare to challenge boundaries and drive progress toward a better world!** If you are not afraid of challenges, wish to grow and leave a lasting impact, this is your opportunity to experience something transformative—not only for others but also for yourself. Are you ready to reach your full potential and make a difference? Join our team and become part of an organization that respects diversity, fosters inclusion, and promotes innovation. Here, every step you take brings you closer to the best version of yourself. **Position Objective:** Ensure the correct and timely execution of the strategy in GMM, hospital supervision, Home Care, and early discharge by efficiently allocating resources and processes across various operational areas, while developing control and monitoring tools that guarantee adherence to productivity, cost, and quality indicators across all processes related to hospital care and discharge management. **Key Responsibilities:** Productivity Management and Assignment: * Ensure daily and effective assignment of productivity to the Assessment areas, supervising that hospitalization, early discharge, Home Care, and hospital supervision processes are executed within established timeframes. * Supervise the 24/7 component to ensure continuous and appropriate patient care. Hospital Supervision and Discharge: * Coordinate and manage hospital care for approximately 80 individuals, including analysis of hospitalized patients, identification and contact with physicians and hospitals to facilitate timely discharges. * Supervise and negotiate with hospitals, internal departments, and providers on matters related to discharges, costs, and administrative processes. Tool Development and Monitoring: * Design and maintain dashboards, KPIs, and algorithms enabling real-time monitoring of productivity, deviations, and process compliance in Assessment and specialized management areas. * Implement claim assignment methodologies aligned with operational workflows, ensuring compliance with service standards and internal regulatory requirements. Systems and Application Management: * Supervise the proper functioning of applications used for request intake and assignment, collaborating with the IT team to ensure operational efficiency. Cross-Functional Collaboration: * Provide support to related departments such as Human Resources, Provider Management, Legal, Marketing, and Systems, promoting alignment and joint objective achievement. * Propose and lead strategies with Assessment leaders to improve processes, reduce costs, and ensure appropriate service levels. Cost Containment and Improvement Strategies: * Develop and execute cost-containment strategies for hospital and discharge processes, aligned with the organization’s financial objectives. **Requirements:** * Bachelor’s degree in: Medicine or Administration. * English proficiency: Intermediate (preferred). * Knowledge and experience: 3–5 years of experience in Claims Management, Hospital Supervision, and Direct Payment within the insurance sector. Database and Excel proficiency; dashboard development for control purposes. KPI interpretation. Negotiation skills. * **Competencies:** * Organizational ability * Motivation and inspiration * Business acumen * Results orientation **What We Offer You:** At AXA Mexico, we provide a path to enhance your skills, grow personally and professionally, and live an experience that challenges you to become better every day. Here, your potential is the seed of change—and your progress, the driving force behind transforming lives. **Our Commitment to You:** **Potential:** Grant you autonomy to make decisions and lead change. **Progress:** Listen to and accompany you in your development, expanding your human and professional capabilities. **Care:** Guarantee your holistic well-being—both personal and professional. Ready to take the next step? Know You Can — because at AXA, your success story starts now. **About AXA** Have you ever wondered what it would be like to work somewhere where you can reach your full potential? We are a French multinational company and a global leader in insurance, present in 50 countries with over 95 million customers worldwide. Since 2008 in Mexico, we have protected and cared for nearly 5.9 million Mexicans thanks to our more than 5,000 committed employees. At AXA, we celebrate the diversity of ideas and perspectives, as it makes us stronger. We promote an inclusive, sustainable environment rich with opportunities to learn, collaborate, and create. Here, every idea matters, every voice is valued, and your development is our mission. If you’re ready to take the next step and dare to bring out the best in yourself, AXA Mexico is waiting for you. Dare to live the AXA experience and build a future full of opportunities.