M/SM - Claim Administration (Life Insurance)

About the role

This role oversees all types of claims operations including Fax Claim, Reimbursement, Death Claim, Critical Illness (CI) Claim and related claims, ensuring compliance with SLA targets and regulatory requirements.

Key responsibilities

• Oversee claims operations management for all claim types to meet defined SLA targets
• Review and approve claims payments according to delegated authority, verifying document accuracy and policy conditions
• Assess claims to align with policy coverage conditions and exclusions
• Ensure claims processing accuracy (>= 98%) and timely processing within SLA (>= 98%)
• Establish and maintain claims work standards in accordance with company policy and OIC requirements
• Conduct quality audits on claims work to reduce errors and prevent fraud
• Develop and update Standard Operating Procedures (SOP) for claims to reflect regulatory changes
• Manage, develop and evaluate claims team performance
• Plan workforce allocation and distribute work appropriately based on workload
• Coordinate with related departments including underwriting, finance, legal and customer service to resolve issues and ensure smooth claims operations

Qualifications:

• Ability to review and approve claims payments according to delegated authority
• More over 10 years for experience in claims assessment and evaluation in Life insurance
• Knowledge of quality control and compliance requirements
• People management and team development experience
• Cross-functional coordination and stakeholder management skills
• Ability to prepare statistical reports and analyst trends
• Knowledge of OIC reporting requirements and regulatory compliance