Claims Manager

FWD Insurance; Taguig; On-site; PHP 1,800,000 - 2,400,000; Full time

Job summary

FWD Insurance in Manila is seeking a Claims Manager to lead end-to-end life and health claims, ensuring fair, accurate, and timely adjudication while delivering an exceptional customer experience. You will supervise technical claims assessment, operations, QA, and regulatory compliance.

The role oversees a team of Claims Analysts and Support staff, drives governance and process improvements, and partners with Legal, Underwriting, Reinsurance, and Finance to maintain sound risk management and

Qualifications

• Bachelor's degree in Nursing, Medicine, Allied Health, Business, Insurance, Finance, Law or 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.

Responsibilities

• Lead end-to-end claims adjudication and provide technical oversight on complex and high-value claims.
• Manage claims operations, QA, governance, and compliance with regulatory requirements.
• Oversee a team of Claims Analysts and Support staff and supervise escalation handling.
• Drive process improvements, efficiency, and customer-centric claims practices.
• Collaborate with Distribution, Legal, Underwriting, Reinsurance, Compliance, and Finance.

Skills

Leadership

Claims adjudication

Regulatory compliance

Stakeholder management

Data analysis

Education

Bachelor's Degree (Nursing/Medicine/Allied Health/Business/Insurance/Law or related field)

Job description

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

Key Responsibilities

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.

Ensure claim decisions are consistent with policy provisions, underwriting disclosures, claims philosophy, reinsurer requirements, and regulatory expectations.

Provide direction on claim rescissions, denials, ex-gratia considerations, and special case handling.

Act as the escalation point for disputed claims, appeals, and customer complaints.

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 - Death, Critical Illness, Disability, Hospitalization, Contestable Claims, Fraud investigations & Customer complaint handling
• Proven experience managing teams and operational performance.