Ejecutivo de Servicio Junior Health - Ciudad de México - Willis Towers Watson

    Willis Towers Watson
    Willis Towers Watson Ciudad de México

    hace 3 días

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    Inmobiliaria
    Descripción

    Descripción del puesto

    Buscamos a un colega médico con experiencia en la atención de siniestros que brinde un acompañamiento personalizado a nuestros clientes en asesoría, consultoría e intervención en siniestros de gastos médicos mayores y vida, especialmente para atender clientes VIP.

    El profesional seleccionado será responsable de resolver controversias médico-administrativas en dictámenes y en siniestros de alta complejidad o especialidad en trámites con el cliente y la aseguradora.

    Responsabilidades clave

    1. Trámite y gestión personalizada en siniestros VIP o de clientes clave con aseguradoras en gastos médicos mayores y vida.
    2. Acompañamiento al cliente y recursos humanos en siniestros complejos o controversias en dictámenes.
    3. Revisión integral de condiciones generales y endosos de pólizas, validación médico-administrativa, derechos y quejas de clientes para revisión con aseguradoras.
    4. Intervención directa con áreas de siniestros de aseguradoras ante problemáticas antes, durante y después del alta hospitalaria en pagos directos.
    5. Activación, acompañamiento y seguimiento para agilizar altas hospitalarias por causas de defunción, facilitando la liberación de cuerpos a familiares.
    6. Activación y seguimiento de servicios de home care y case management con aseguradoras.
    7. Gestión de beneficios de descuentos en siniestros no procedentes o rechazados por aseguradoras en pagos directos.
    8. Registro en el benefits engine de siniestros, asegurando trazabilidad, indicadores de gestión y confidencialidad.
    9. Trámite y gestión de siniestros de pólizas de conversión y de vida con aseguradoras, clientes y beneficiarios.
    10. Seguimiento al protocolo de escalamiento para resolución de problemas o quejas de clientes.
    11. Participación en capacitaciones quincenales y actualizaciones relacionadas con siniestros en gastos médicos mayores y vida.

    Requisitos y habilidades

    1. Empatía, amabilidad, cordialidad, buen trato, buena escucha, actitud de servicio y capacidad para manejar diferentes perfiles y situaciones de estrés.
    2. Ser proactivo y anticiparse a problemas en siniestros, asegurando asesoría adecuada y revisión de información del cliente.
    3. Experiencia en trámite, asesoría y atención de siniestros en gastos médicos mayores y vida en brokers o aseguradoras.
    4. Conocimiento intermedio en Microsoft Office (Excel, PowerPoint, Word).
    5. Capacidad de comunicación en inglés según necesidades del cliente.
    6. Disponibilidad para atender asuntos emergentes en cualquier horario.
    7. Tolerancia al trabajo bajo presión y manejo de frustraciones.
    8. Habilidad para gestionar quejas, controversias y situaciones de presión.
    9. Comunicación efectiva y habilidades de escucha.
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