Manager, Claims

Main Responsibilities:

• Lead the Claims team to handle all types of claims from clients (e.g. death, CI, hospitalization, accident claims, etc.) and achieve our commitment of claims turnaround time
• Monitor and evaluate the performance of claim assessors and provide technical training and coaching to them
• Review guidelines/ manuals, service standards and the workflows in relation to claims.
• Ensure all team members follow the related guidelines/ manuals and workflows so that to meet the service standards and enhance the smoothness of the daily claims operation
• Evaluate and approve all types of claims applications with the assigned authority
• Handle claims complaint received from client and regulator such as ICB
• Perform the investigation of suspicious/ fraudulent claims and ensure timely report to the Management
• Participate in product development, comment on the product features / suggest possible product features to Product Development team from claims perspectives
• Provide comment on user requirements in relation to claims
• Conduct Quality Assurance review to maintain good quality for claims settlement
• Review and update claims forms in order to enhance the customer experience
• Deliver training to agents and staff of other departments in claims area if necessary
• Ensure timely report of Claims related KRI to Risk
• Prepare claims statistics to the Management
• Communicate with reinsurer on claims cases handling and seek for their support when necessary
• Assist to review reinsurance treaty for claims section to ensure the claims benefit is well defined

Job Specification:

•  Academic & Professional Qualifications
  • Degree Holder
  • Fellow, Life and Management Institute (preferred)
  • Associate Life and Health Claims
• At least 8 years of Life and Medical claims assessment experience
• At least 3 years in managing the Claims department
• Proficiency in English and Chinese; Fluent in Mandarin would be an advantage
• Strong customer-oriented mindset and skills
• In-depth knowledge in life insurance
• Effective communication skills and high level of integrity