Claims Manager

FWD Group Management Holdings Limited; Taguig; Hybrid; PHP 1,800,000 - 3,000,000; Full time

Job summary

FWD Group is seeking a senior Claims Manager to lead the end-to-end claims function for life and health insurance. The role requires technical oversight of complex claims, team leadership, and governance to ensure fair, timely adjudication and excellent customer outcomes.

The candidate will manage a team of Analysts and Support staff, drive process improvements, and collaborate with multiple internal functions to ensure compliant and efficient claims operations.

Qualifications

• Bachelor's degree in a related field.
• 8–10 years of insurance industry experience.
• 3–5 years in claims leadership or supervisory roles.
• Professional certifications in insurance, claims management, fraud investigation, medical underwriting, or risk management are an advantage.

Responsibilities

• Provide technical leadership in adjudication of life and health insurance claims.
• Manage end-to-end claims workflow from notification to payout with SLA adherence.
• Lead and develop the claims team, driving performance and capability growth.
• Ensure governance, risk, and compliance with regulations and internal controls.
• Collaborate with Distribution, Legal, Underwriting, and Finance to resolve escalated claims.

Skills

Leadership

Claims management

Regulatory compliance

Vendor management

Data analysis

Education

Bachelor's degree (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

The Claims Manager

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.
• 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.
• 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.
• 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.
• 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

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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

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