Claims Technical Excellence

AIA Hong Kong; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

A leading insurance provider is seeking a seasoned professional to serve as a subject matter expert for claims technical matters across Life and Health insurance products. The ideal candidate should have 10-15 years of experience in Claims Operations, with expertise in governance, risk management, and fraud detection. This role involves leading the development of Group Claims guidelines and collaborating with stakeholders to enhance claims capabilities. Strong leadership and influencing skills are essential for success in this position.

Qualifications

• Minimum 10-15 years of experience in Claims Operations, preferably in a regional or group-level role.
• Proven experience in claims governance, risk management, and fraud detection.
• Strong organizational and management skills to lead multi-functional teams.
• Strong influencing skills to engage partners and stakeholders in the delivery of key goals.
• Effective communication and relationship skills to engage senior level stakeholders.
• Experience in driving end-to-end Claims automation and STP for Life and Health Claims.

Responsibilities

• Manage and maintain Group-wide Operations Standards and procedures.
• Support the review and assessment of high-value claims to ensure accuracy.
• Collaborate with stakeholders to deliver innovative Claims capabilities.
• Champion data-driven decision-making to define claims analytics and KPIs.
• Lead the development and improvement of Group Claims guidelines and frameworks.
• Support the development of claims operation model for growing markets.

Skills

Claims Governance

Risk Management

Fraud Detection

Data-driven Decision Making

Leadership

Stakeholder Engagement

Claims Automation

Job description

About the Role

• Serves as the subject matter expert (SME) for claims technical matters across Life and Health insurance products across the Group and AIA entities and works closely with the business and claims operations team.
• Lead the development and continuous improvement of the Group Claims guidelines and framework.
• Establish Claims Technical Excellence across the Group to increase competitive advantage by strengthen claim control and risk management
• Responsible for the execution & governance of group’s integrated health strategy for healthcare claims administration

Responsibilities include, but are not limited to, the following:

• Claims Governance, Control and Risk Management
  • Manage and maintain Group-wide Operations Standards, procedures and guidance notes to ensure consistent governance and effective risk mitigation
  • Collaborate with key stakeholders to complete the risk and compliance reporting requirements for various forums
  • Drive the achievement of Group business goals in Claim control and risk management
• Support the review and assessment of high-value claims to ensure accuracy and integrity.
• Collaborate with key stakeholders to deliver new innovative Claims capabilities to support the delivery of Group business goals (Gen AI, AI based FWA and auto adjudication, OCR and claims processing)
• Champion data-driven decision-making by defining claims analytics and KPI’s that reflect quality, turnaround and leakage metrics.
• Lead the development and continuous improvement of the Group Claimsguidelines and framework.
• Support the development of claims operation model for growing markets
• Perform operational due diligence to support potential M&A

Job Requirements :

• Minimum 10-15 years of experience in Claims Operations, preferably in a regional or group-level role.
• Proven experience in claims governance, risk management and fraud detection
• Strong organisational and management skills to lead multi-functional teams
• Strong influencing skills to engage partners and stakeholders in the delivery of key goals
• Effective communication and relationship skills to engage senior level stakeholders
• Ability to demonstrate independent leadership, judgment, and decision making
• Ability to adjust to multiple and changing priorities, remaining flexible, open, and collaborative
• Experience in driving end to end Claims automation and STP for Life and Health Claims
• Exposure to digital transformation initiatives in claim (e.g. AI, OCR, auto adjudication)

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

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