Manager, Claims

Key responsibilities

• Lead and oversee the end-to-end Health Claims operations, including hospitalization, surgical, outpatient, medical reimbursement, and group medical claims
• Ensure claims are assessed fairly, consistently, and in accordance with policy contracts, Claims SOPs, medical guidelines, and regulatory requirements
• Monitor and improve claims turnaround time (TAT), productivity, accuracy, and customer satisfaction
• Lead claims digitalisation initiatives and system enhancements, including business requirement gathering, UAT, implementation, and post-production monitoring
• Collaborate with IT, product, underwriting, and external vendors to enhance claims capabilities and straight-through processing (STP)
• Ensure compliance with internal policies, Claims SOPs, BNM regulatory requirements, Takaful/Insurance standards, and FWD Group governance requirements
• Lead and manage Third Party Administrator (TPA) relationships to ensure service quality, turnaround time, operational efficiency, and contractual compliance
• Lead claims reporting and analytics to identify trends, operational issues, leakage risks, and improvement opportunities
• Lead, coach, develop, and motivate the Claims team to enhance technical competency, productivity, and customer-centric culture
• Support succession planning, capability building, and performance management initiatives

About you

• Bachelor's degree in insurance, Medicine, Nursing, Biomedical Science, Pharmacy, Health Sciences, Business Administration, or related disciplines
• Minimum 7-10 years of experience in Health Claims operations
• Minimum 3 years of people management experience
• Experience managing TPAs, healthcare providers, and vendor performance
• Strong knowledge of medical and health insurance claims assessment
• Good understanding of insurance and takaful products
• Strong knowledge of healthcare billing, medical procedures, and hospital claims administration
• Knowledge of BNM regulations, industry guidelines, and claims governance requirements
• Experience with claims administration systems and workflow management tools
• Data analytics, reporting, and dashboard interpretation skills