Claims Manager

Philippine Future Providers PFP Inc.; Pateros; On-site; PHP 1,800,000 - 3,000,000; Full time

Job summary

FWD Life Philippines seeks a seasoned Claims Leader to drive end‑to‑end adjudication, operational excellence, and regulatory compliance across life and health claims. You will lead a team of analysts, oversee complex and high‑value cases, and collaborate with multiple functions to ensure fair, timely, and accurate claim outcomes.

The role emphasizes governance, risk management, and continuous process improvement within a customer‑centric framework.

Qualifications

• Bachelor's degree in Nursing, Medicine, Allied Health, Business Administration, Insurance, Finance, Law, or a related field.
• Professional certifications in insurance, claims management, fraud investigation, medical underwriting, or risk management are an advantage.
• Minimum 8–10 years of insurance industry experience.
• Minimum 3–5 years in claims leadership or supervisory roles.
• Demonstrated experience handling different types of claims.
• Proven experience managing teams and operational performance.

Responsibilities

• Lead end-to-end claims adjudication and provide technical leadership for Death, Critical Illness, Disability, and other major claims.
• Oversee claims operations, QA, and compliance with regulations and internal policies.
• Manage a team of Claims Analysts and a Claims Support staff with performance development.
• Maintain governance, risk controls, and fraud prevention initiatives within claims.
• Collaborate with Distribution, Customer Experience, Legal, Underwriting, and Finance for cross-functional projects.

Skills

Leadership

Claims management

Operations oversight

Governance & compliance

Vendor management

Education

Bachelor's degree in Nursing, Medicine, Allied Health, Business Administration, Insurance, Finance, Law, or related field

Job description

About FWD Group

FWD Group (1828.HK) is a pan-Asian life and health insurance business that serves approximately 40 million customers across 10 markets, including BRI Life in Indonesia. FWD’s customer-led and tech-enabled approach aims to deliver innovative propositions, easy-to-understand products and a simpler insurance experience. Established in 2013, the company operates in some of the fastest-growing insurance markets in the world with a vision of changing the way people feel about insurance. FWD Group is listed on the main board of the Hong Kong Stock Exchange under the stock code 1828.

For more information, please visit www.fwd.com

About FWD Life Philippines

FWD Life Insurance Corporation (FWD Life Philippines) launched its commercial operations in September 2014. As of end-2022, FWD Life Philippines ranks 3rd and 6th in terms of Paid-up Capital(1) and New Business Annual Premium Equivalent(2), respectively.

For more information, please visitfwd.com.ph.

1 www.insurance.gov.ph > Statistics > Life > 2022 > Based on Paid-Up Capital

2 www.insurance.gov.ph > Statistics > Life > 2022 > Based on New Business Annual Premium Equivalent

The Claims Manager is responsible for leading the end-to-end claims function, ensuring fair, accurate, and timely adjudication of life and health insurance claims while delivering an exceptional customer experience. The role oversees technical claims assessment, claims operations, quality assurance, regulatory compliance, people leadership, and continuous process improvement.

The incumbent will manage a team of Claims Analysts and Claims Support staff and serve as the technical authority for complex, contestable, escalated, and high-value claims involving Death, Critical Illness, Disability, Hospitalization, Waiver of Premium, and related benefits. The role also drives operational efficiency, governance, risk management, and customer‑centric claims practices. This aligns with internal claims approval, assessment, payment, QA, and escalation processes documented in your claims operations materials

1. Claims Adjudication and Technical Leadership

Provide technical oversight on the assessment and adjudication of:

• Death Claims
• Contestable and Incontestable Claims
• Critical Illness Claims
• Total and Permanent Disability Claims
• Waiver of Premium Claims
• Hospitalization and Medical Reimbursement Claims

Review and approve claims within delegated authority limits.

Assess complex, high‑exposure, contestable, fraudulent, or litigated claims.

Evaluate medical, financial, occupational, legal, and investigative information to determine claim validity.

2. Operations Management

Manage the end-to-end claims workflow from claim notification to benefit settlement.

Ensure delivery of service level agreements (SLAs), turnaround times, and productivity targets.

Monitor claim inventories, aging reports, pending requirements, and backlog management.

Drive operational excellence initiatives to improve efficiency, quality, and customer outcomes.

Analyze claims data, trends, and operational metrics to identify opportunities for improvement.

Oversee vendor relationships involving investigators, medical reviewers, legal counsel, and third‑party service providers.

Ensure proper documentation and maintenance of claim records and audit trails.

3. People Leadership and Talent Development

Lead, coach, and develop a high‑performing claims team.

Conduct performance management, talent reviews, career development planning, and succession planning.

Strengthen technical claims capability through training, case reviews, and calibration sessions.

Foster a culture of accountability, customer focus, collaboration, and continuous learning.

Drive employee engagement and team effectiveness.

4. Governance, Risk, and Compliance

Ensure compliance with Insurance Commission regulations, Anti‑Money Laundering requirements, data privacy regulations, and company policies.

Maintain robust claims controls and quality assurance programs.

Support internal audits, regulatory reviews, and compliance assessments.

Monitor fraud indicators and lead fraud prevention initiatives.

Ensure adherence to claims authority frameworks and approval hierarchies

5. Stakeholder and Customer Management

Partner with Distribution, Customer Experience, Legal, Operations, Underwriting, Reinsurance, Compliance, and Finance teams.

Manage escalated distributor, customer, and beneficiary concerns.

Represent Claims in cross‑functional projects and strategic initiatives.

Support customer advocacy while ensuring sound risk management and fair claims outcomes.

Job Requirements

• Bachelor's Degree in Nursing, Medicine, Allied Health, Business Administration, Insurance, Finance, Law, or a related field.
• Professional certifications in insurance, claims management, fraud investigation, medical underwriting, or risk management are an advantage.
• Minimum 8–10 years of insurance industry experience.
• Minimum 3–5 years in claims leadership or supervisory roles.
• Demonstrated experience handling different types of claims.
• Proven experience managing teams and operational performance.
• Exudes claims expertise, operational excellence and leadership competence

Privacy Notice

Your privacy is a priority for FWD. The Company keeps your personal information with us in confidence. To know more about how we process your information, kindly refer to our FWD Recruitment Privacy Notice.

FWD has partnered with Talocity Instasolutions Private Limited (“Talocity”) to manage the initial filtering of candidate’s profiles through video interviews, social profile mapping, and video analytics using artificial intelligence engine that is offered within the Talocity platform. The platform evaluates the candidate on the five well‑known dimensions as per OCEAN Personality Model that influence occupational success and help understand workplace behavior. For more information, please refer to Talocity Privacy Policy.

When you apply, FWD will share your name, phone number and email address to Talocity to contact you and conduct the initial screening and profiling process. Shortlisted candidates will then be contacted by FWD for the face‑to‑face interview.