Claims Officer

QBE Group Shared Services Centre; Philippines; On-site; PHP 350,000 - 550,000; Full time

Job summary

QBE Group Shared Services Centre in the Philippines is seeking a claims professional responsible for end-to-end management of claims, including decision making, customer interaction, supplier coordination and claim finalization. This role operates within SLA targets and regulatory requirements to deliver accurate settlements.

You will analyze policy coverage, identify fraud indicators, and coordinate with underwriters to determine the optimal settlement.

Qualifications

• Bachelor's Degree or equivalent combination of education and work experience.
• Strong customer service and communication skills.
• Knowledge of claims processing and insurance basics is a plus.

Responsibilities

• Manage claims end-to-end within policies and regulatory requirements.
• Ensure compliance within delegated authority and SLAs.
• Maintain proactive customer communication and coordinate with suppliers.
• Set claim cost and provide timely updates to assessors and management.
• Process payments within authority and triage documents for settlements.
• Identify fraud indicators and escalate to Fraud Investigations when needed.
• Suggest recovery opportunities and provide feedback to underwriters.

Skills

Customer service

Analytical skills

Communication

Education

Bachelor's Degree or equivalent

Tools

MS Office

Job description

Primary Details

Time Type: Full time

Worker Type: Employee

This role is responsible for end-to-end claims management of claims. This includes making decisions on claim outcome, declining claims, customer interaction (inbound and outbound), supplier coordination, raising payments to suppliers and claim finalization. This role is also responsible for keeping portfolios compliant to SLAs measured.

Primary Responsibilities

• Manage claims end-to-end within parameters of claims manual, DTPs, GSSC policies and relevant legislation and regulations.
• Ensure compliance within delegated authority limits
• Maintain effective and proactive communication with customers
• Ensure effective coordination with suppliers
• Set possible cost of claim and updates on time as reports are sent through by assessors
• Raises payment within delegations of authority
• Interpreting policy coverage and determining if coverage's apply to claims submitted. Promptly informing customer of acceptance/ decline of claim and escalating issues or proper endorsement as needed.
• Decide on the best fulfillment method to settle claim.
• Identify suspicious or potentially fraudulent claims in accordance with QBE fraud indicators. Refer these claims to the Fraud Investigations team.
• Identify recovery opportunities on claims
• Provide information and feedback on claims activity and developing trends to underwriters/risk assessors to enable appropriate actions to be carried out
• Provide feedback to the underwriting team for details that need to be flagged/ noted in the policy that is relevant upon renewal.
• Complete uploading and allocation activities to triage documents and claims to the relevant teams (Claims settlements)
• Utilize appropriate settlement strategies and tactics for the best commercial outcomes by achieving KPI target (Claims settlements)
• Review claim documents to identify cases where liability is disputed for triage to the appropriate claims officers (Claims settlements)
• Seeking continuous process, policy and procedure improvement alongside keeping up to date with current and new compliance requirements (Claims settlements)

Required Education

• Bachelor's Degree or equivalent combination of education and work experience

Required Experience

• NA Preferred Competencies/Skills
• Customer service skills
• Proficiency in MS tools
• Analytical and negotiation skills
• Excellent verbal and written communication skills (English)
• Preferably with Case Management Skills
• Preferred Basic Knowledge of Insurance
• Basic Knowledge of Customer Service

QBE Cultural DNA

Everything we do at QBE is underpinned by our DNA (which interlinks seven cultural elements) – because we know it's not just what we do that matters, it's how we do it that makes the difference. We expect all employees to role model and inspire the right behaviours that link to our cultural elements:

• We are customer-focused
• We are technical experts
• We are inclusive
• We are fast-paced
• We are courageous
• We are accountable
• We are a team

All employees are expected to adhere to QBE’s Code of Ethics and Conduct and apply sound risk management practices US Only - Disclaimer

To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities. Global Disclaimer

The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee’s normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls.

Skills

Analytical Thinking, Claims Administration, Claims Processing, Claims Resolution, Communication, Critical Thinking, Customer Service, Customer Value Management, Financial Advising, Intentional collaboration, Managing performance, Process Compliance, Process Improvements, Risk Management, Stakeholder Management

Equal Employment Opportunity

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.