The Claim Manager is responsible for overseeing and managing the technical and operational aspects of Life insurance claims. The role ensures that all claims are assessed accurately, consistently, and in compliance with company policies and regulatory requirements.
The position focuses on enhancing operational efficiency, strengthening risk control (including fraud and abuse detection), and developing team capabilities. The role also contributes to continuous improvement initiatives and supports the expansion of claims management scope across both Life and Health insurance lines.
Responsibilities
Lead, train, and develop Claims assessors to ensure strong technical capability and consistent decision-making quality.
Provide coaching and professional guidance, particularly for staff with non-medical backgrounds.
Assign work, monitor performance, and support resolution of complex claims cases.
Oversee the end-to-end Life claims assessment process, ensuring compliance with internal policies, regulatory requirements, and service standards (SLA/TAT).
Maintain high standards of accuracy, quality, and consistency in claims decisions.
Analyze claims data to identify trends, emerging risks, and abnormal patterns.
Strengthen risk management through effective detection and prevention of fraud and abuse.
Prepare regular reports and provide insights to support management decision-making.
Drive and contribute to claims process improvement and transformation initiatives.
Identify operational inefficiencies and propose solutions to enhance productivity, quality, and turnaround time.
Participate in system enhancement and automation initiatives.
Build capability and readiness to expand management scope across both Life and Health claims functions.
Collaborate with Underwriting and other stakeholders to ensure alignment in risk assessment and claims handling practices.
Ensure compliance with legal, regulatory, and internal governance requirements.
Perform other duties as assigned by line manager in support of departmental and organizational objectives.
Job Specifications
Bachelor's degree or higher in a relevant field, medical background is preferred
A minimum of 5 years of experience in the insurance industry, with at least 2 years in a managerial or supervisory role within claims.
In-depth knowledge of insurance products claims procedures, and relevant legal regulations. Deep understanding of specific insurance lines (e.g., health, life).
Skills: Excellent leadership and team management skills, Sharp analytical and decision-making skills, Effective communication and negotiation skills, Strong problem-solving skills and adaptability in handling situations, Proficiency in Microsoft Office Suite and claims management software,
Honest, meticulous, highly responsible, and capable of working well under pressure.
