JOB PURPOSE

Provide operational direction for claims management at the departmental level, ensuring process optimization, risk control, and service quality. Simultaneously, develop a skilled claims team and drive strategic collaboration with other departments to enhance operational efficiency and customer satisfaction.

KEY ACCOUNTABILITIES

1. Claims Operations and Technical Oversight

- Oversee the end-to-end claims process, from intake and assessment to approval and payout, ensuring every step is executed in accordance with company policies, regulatory standards, and service-level expectations.

- Develop and continuously enhance claims workflows to accommodate various life insurance products including death, critical illness, accidental coverage, health riders, and waiver-of-premium benefits.

- Handle complex and high-value claims, especially those involving legal disputes, suspected fraud, sensitive medical conditions, or contested beneficiary entitlements, in collaboration with external assessors or legal counsel.

- Analyze claims data and trends to detect anomalies such as spikes in claims from specific geographies, product lines, or time periods; collaborate with Underwriting and Risk teams to design mitigation strategies.

- Coordinate with internal functions such as Reinsurance, Legal, and Internal Audit for the effective management of flagged cases and to ensure thorough documentation and compliance with procedural checkpoints.

- Maintain internal control mechanisms, including verification checklists, audit routines, and case quality reviews to enhance accuracy, transparency, and regulatory alignment.

- Monitor core operational indicators, such as approval-rejection ratios, processing turnaround time, customer complaints, and documentation completeness to identify improvement areas and sustain high performance.

- Provide technical guidance to team leaders and frontline staff, ensuring updated knowledge and consistent application of procedural guidelines, especially in response to regulatory changes or policy updates.

- Represent the unit in strategic planning forums, sharing operational insights, performance reports, and proposals to improve enterprise-wide claims efficiency.

2. Process Improvement and Strategic Collaboration

- Contribute to the development and implementation of the digital transformation strategy for Claims, proposing technological solutions such as e-submission integration, scheduled claims automation, AI-driven risk detection, and SLA/KPI tracking dashboards.

- Coordinate closely with departments including Underwriting, Product, Customer Service, IT, and Legal to address specific claims requirements, respond to customer inquiries, and enhance policy administration systems.

- Oversee departmental budget and resource planning, including costs related to external medical assessors, system operations, and technology tools, ensuring efficient expenditure aligned with organizational financial goals.

- Participate in the evaluation and selection of strategic external partners, such as medical assessment providers, legal counsel, reinsurers, audit firms, and claims technology vendors, building sustainable relationships with clear accountability and long-term effectiveness.

- Engage in enterprise-wide improvement initiatives, including digital transformation projects, end-to-end claims process reviews, omnichannel customer experience programs, and integrated risk management strategies.

QUALIFICATIONS AND WORK EXPERIENCE

-Education: Bachelor's degree or higher in Insurance, Finance, Law, Risk Management, or relevant fields.

-Advanced degrees or professional certifications (e.g. FLMI, ICA, CPCU) are preferred.

-Work Experience: Minimum of 08 years in life insurance claims, including at least 4 years in senior leadership roles.

-Candidates with national or regional claims oversight experience in top-tier insurance firms or financial institutions will be prioritized.

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