Lead and manage day-to-day claims operations to ensure timely and accurate claim adjudication and settlement.
Ensure all claims are assessed in accordance with company policies, underwriting provisions, regulatory requirements, and benefit entitlements.
Monitor and continuously improve claims processing efficiency, productivity, and service quality standards.
Manage complex, high-value, and escalated claims including fraud-suspected cases.
Drive continuous process improvement and automation initiatives within claims operations.
Collaborate closely with the New Business & Underwriting and Alteration & Billing teams to ensure alignment between policy administration and claims processes.
Ensure compliance with internal controls, operational risk standards, audit requirements, and regulatory obligations.
Analyze claims trends, loss experience, claims leakage, and fraud indicators, providing actionable recommendations for improvement.
Prepare operational reports, claims analytics, management dashboards, and strategic recommendations for the Operation Group Head.
Requirements:
Bachelor's Degree in Insurance, Medicine, Pharmacy, Nursing, Business Administration, Finance, Law, or related disciplines.
Profesional insurance certifications such as AAAIK, AAIJ, FLMI, ALHC, or equivalent are highly preferred.
Minimum 8-10 years of experience in Life Insurance Claims Operations.
Minimum 3-5 years in managerial or team leadership position.
Strong expertise in Medical Claims, Life Claims, Health Claims, and Claim Investigation.
Experience managing outsourced workforce and vendor performance.
Proven track record in process improvement, operational excellence, and transformation initiatives.
Strong leadership and people management capabilities, with the ability to build, develop, and motivate high-performing teams.
In-depth knowledge of life insurance claims management, medical claims assessment, claims investigation, and fraud detection.
