Claims Officer

The Claims Officer is responsible for overseeing daily claims operations and ensuring that insurance claims are processed accurately, efficiently, and in accordance with policy terms, regulatory requirements, and company standards. The role coordinates with clients, insurers, and internal teams to facilitate timely and fair claims resolution and serves as an escalation point for complex or high-priority cases.

Key Responsibilities

Claims Management

• Coordinate with insurers and clients to ensure timely processing and resolution of claims.
• Review and assess claims by gathering and evaluating relevant information and documentation.
• Ensure insurer claim decisions are consistent with the applicable policy coverage, terms, and conditions.
• Monitor claim status and provide timely updates to clients and concerned stakeholders.
• Negotiate claim settlements and ex gratia settlement requests when appropriate.
• Ensure claims are resolved within established timelines and service standards.

Team Supervision & Collaboration

• Lead, mentor, and provide guidance to claims staff to improve productivity and service quality.
• Monitor team performance and support training and development initiatives.
• Conduct performance reviews and promote a positive and productive work environment.
• Collaborate with account management teams, clients, insurers, and other stakeholders to obtain information necessary for claim resolution.

Customer Service

• Act as the escalation point for complex, sensitive, or high-priority claims.
• Address client inquiries, concerns, and complaints professionally and promptly.
• Maintain strong working relationships with clients and insurance providers throughout the claims process.

Compliance, Reporting & Process Improvement

• Ensure claims activities comply with applicable regulations, insurance policies, and company procedures.
• Conduct quality checks and audits to identify errors, inconsistencies, and process gaps.
• Maintain complete and accurate claims documentation and records.
• Analyze claims data to identify trends, risks, and opportunities for improvement.
• Recommend and assist in implementing process improvements to enhance efficiency and service quality.
• Prepare regular reports on claims performance, productivity, and key operational metrics.

Qualifications

• Bachelor's degree in Business Administration, Management, Insurance, or a related field.
• At least 5 years of experience in insurance claims processing, with 1–2 years in a supervisory or leadership role.
• Strong knowledge of life and general insurance products, claims procedures, policy coverage, and regulatory requirements.
• Experience using claims management systems and related software.
• Experience handling complex claims and client escalations is an advantage.

Skills & Competencies

• Strong leadership and team management skills
• Excellent analytical and decision-making abilities
• Strong communication and interpersonal skills
• High attention to detail and accuracy
• Good negotiation and problem-solving skills
• Customer service orientation
• Ability to manage multiple claims and priorities
• Ability to remain professional and effective in complex or high-pressure situations
• Strong organizational and time-management skills

Pay: Php45,000.00 - Php55,000.00 per month

Work Location: In person