Manager, CI Claims Assessment

FIND YOUR 'BETTER' AT AIA

We don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us.

We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.

If you believe in better, we’d love to hear from you.

About the Role

Lead and manage the Critical Illness Claim team to ensure accurate and timely claim assessment and decision-making within authorized limits, while driving operational excellence through data analytics, system and procedure management, and effective communication with customers and stakeholders.

1. Claims Assessment

• Set goals and objectives for the Critical Illness Claim team to achieve operational results in claim assessment, reporting, and stakeholder engagement.
• Conduct claims assessment to ensure accurate and fair evaluation of Critical Illness claims.
• Manage claim decisions within authority level D, ensuring fairness, accuracy, and timeliness.
• Ensure compliance with claim policies, practices, and procedures across all team activities.
• Collaborate cross-functionally to resolve complex claim issues and support strategic initiatives.
• Collaborate Re-insurers to get their experiences for claim process.

2. Quality Assurance

• Monitor and audit claim handling processes to maintain accuracy and efficiency, including conducting audits, providing feedback to staff, and implementing improvements.
• Oversee system and procedure enhancements to improve claim processing efficiency.

3. Customer Service

• Address inquiries and issues related to claims from healthcare providers, policyholders, and internal stakeholders by providing clear explanations and resolving disputes.
• Communicate and negotiate effectively with internal and external stakeholders, including customers, medical providers, and legal entities.
• Represent the Claims Department to share claim experiences with GADs and agents to ensure thorough understanding of claims procedures.

4. Data Analysis and Claims Efficiency

• Utilize data analytics to monitor performance, identify trends, and support continuous improvement.
• Analyze claims data to identify trends, patterns, and areas for improvement, helping to optimize claims processes, reduce errors, and detect/prevent fraud, abuse, and waste.

5. Team Management

• Supervise and develop claim specialists, providing guidance, training, and performance management.
• Lead a team of claims processors and coordinators, including training, mentoring, and ensuring staff have the necessary resources to perform their roles effectively.
• Ensure claims are processed accurately, efficiently, and in compliance with regulations, contributing to the financial health and operational success of the organization.
• Manage stakeholders’ expectations efficiently to balance company benefits and customer experiences.
• Manage provider relationships to ensure smooth operations between the Health Claims team and providers, especially in direct billing scenarios.

6. Product Development

• Collaborate with Product and Actuarial teams to contribute claim insights during product development, ensuring clear terms and conditions that enhance customer understanding and minimize claim losses.

Job requirement:

Internal:

• Frequent interaction with Claims, Legal, Compliance, Operations, and Customer Service teams to align on claim decisions and process improvements.

External:

• Communication with customers, hospitals, legal representatives, and Re-insurers to explain claim decisions, resolve disputes, and ensure transparency

Education:

• Bachelor’s degree or higher in Law or Medical Doctor
• LOMA certifications: 280, 290, 301, ACS

Experience:

• Minimum 3 – 5 years in Life Insurance Claims
• At least 3 – 4 years in a managerial role

Skills (Technical):

• Advanced knowledge of Life Insurance and legal frameworks
• Strong analytical and decision-making skills
• Proficiency in claim systems and reporting tools

Will (Soft Skills):

• Leadership and team development
• Agility and adaptability in a dynamic environment
• Strong communication and negotiation skills

Thrill (Potential):

• Opportunity to progress to Senior Manager or Head of Claims roles
• Exposure to strategic projects and cross-functional leadership

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.