Head of Minor Claims QA and Investigation

At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.

It's about finding new ways to not only better people's lives, but to better the communities and environments we live in. We need great Actuaries who want to be part of something bigger than finance alone. Because the better we can nurture our financial wellbeing as an organisation, the better we can support and make a difference for our customers when they need us most. By ensuring our products are well designed and priced, analysing business performance and ensuring proper management of insurance policies in-force, you're not just safeguarding AIA's financial wellbeing. You're securing a better future for the people and communities we serve - today, tomorrow and for generations to come.

If that interests you, read on.

About The Role

AIA is seeking an experienced Head of Minor Claims QA and Investigation to lead and oversee the Claims Quality Assurance and Investigation functions to ensure claim decisions are accurate, consistent, and compliant with policy provisions, internal procedures, and regulatory requirements. The role is responsible for strengthening claim quality governance, enhancing fraud risk management, driving continuous process improvements, and developing team capabilities to support operational excellence and customer trust.

Roles & Responsibilities:

1. Lead and manage the Minor Claims QA function for Individual and Group Claims to ensure claim assessments are performed accurately and consistently.
2. Develop and maintain QA frameworks, methodologies, and review standards in accordance with policy provisions, company guidelines, and regulatory requirements.
3. Conduct quality reviews on processed claims, including benefit calculations, policy interpretation, and documentation completeness.
4. Analyze QA findings, identify root causes of errors, and recommend corrective and preventive actions.
5. Prepare and present periodic QA reports, trends, and improvement recommendations to management and relevant stakeholders.
6. Monitor claim quality performance indicators and drive initiatives to improve claim accuracy and operational effectiveness.
7. Lead and oversee investigation activities for suspicious, complex, or high-risk claims.
8. Ensure investigation outcomes and recommendations are aligned with policy provisions, company standards, and regulatory requirements.
9. Manage and monitor external investigation vendors to ensure service quality, cost efficiency, and SLA achievement.
10. Review investigation findings and provide recommendations for claim decisions, fraud prevention, and risk mitigation.
11. Support the development and implementation of fraud detection and prevention initiatives.
12. Develop, maintain, and regularly review SOPs, guidelines, and governance documents related to Minor Claims QA and Investigation.
13. Identify opportunities to improve claims processes, quality, efficiency, and customer experience.
14. Lead and participate in strategic projects, system enhancements, and digital transformation initiatives.
15. Ensure compliance with regulatory requirements, internal controls, and audit standards. People Management
16. Lead, coach, and develop Minor Claims QA and Investigation team members to ensure high performance and capability development.
17. Establish individual performance objectives and monitor team achievement.
18. Conduct regular coaching, knowledge-sharing sessions, and technical training programs.
19. Foster a culture of quality, accountability, continuous improvement, and risk awareness.

Requirements:

• Bachelor's Degree in Medicine (Medical Doctor) preferred.
• Additional insurance qualifications (AAJI, ALMI, FLMI, HIA, CFE, ICA) would be an advantage.
• Minimum 5 years of experience in Life and Health Insurance Claims.
• Minimum 3 years of experience in leadership or managerial roles.
• Experience in Claims Quality Assurance, Claims Investigation, Fraud Management, or Claims Technical Assessment is highly preferred.
• Strong understanding of Life and Health Insurance products and policy provisions.
• Strong medical knowledge and claim assessment capability.
• Knowledge of fraud investigation principles and risk management practices.
• Strong analytical, problem-solving, and decision-making skills.
• Strong stakeholder management and communication skills.
• Good command of written and spoken English.
• Proficiency in Microsoft Office (Excel, PowerPoint, Word) and data analysis tools.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.