Claims Officer For Pooling

AXA Philippines; Makati; On-site; PHP 420,000 - 600,000; Full time

Job summary

AXA Philippines is seeking a Life Claims Officer to review and decide on individual life insurance claims, ensuring timely settlement and compliance. The role requires strong analytical skills, attention to policy terms, and effective communication with policyholders, brokers, and partners. You will contribute to improving claims processes and uphold data privacy standards.

Experience in processing life claims and familiarity with CPCU/LOMA certifications would be a plus.

Qualifications

• Bachelor’s degree; paramedical course preferred but not required.
• Certification in insurance (CPCU, LOMA) is a plus.
• At least 3 years of experience in processing life claims or related investigations.
• Strong computer literacy with MS Office applications.
• Excellent verbal and written communication with policy terms.
• Knowledge of data privacy and regulatory requirements in insurance.

Responsibilities

• Review life claims and verify submitted information.
• Assess claims against policy terms, conditions, and exclusions.
• Process claims for payment and ensure accurate coding.
• Examine claims for fraud or abuse.
• Ensure compliance with internal policies and regulatory standards.
• Communicate with employees, beneficiaries, and stakeholders to resolve questions.
• Identify complex or suspicious claims for review.
• Calculate payouts and draft settlement letters.
• Maintain detailed claim records and processing notes.
• Contribute to improvements in claims procedures.

Skills

Life insurance claims

Claims processing

Communication skills

Interpersonal skills

Negotiation

Data privacy

Regulatory compliance

Education

Bachelor's degree

Paramedical course (preferred)

Insurance certifications (CPCU, LOMA)

Tools

MS Office

Job description

Job Description:

MAIN PURPOSE

Of The Job

The purpose of a Life Claims Officer is to review, assess, recommend, and/or make decisions on individual life insurance or claims originating through strategic partnerships, employee benefits-related life insurance claims submitted by policyholders, employees, beneficiaries, brokers, HR or other authorized parties ensuring accurate and timely settlement while maintaining collaboration with partner organization or distributors.

Key Accountabilities

• Reviewing life claims and verifying the accuracy of submitted information
• Assess claims against policy terms, conditions, and exclusions
• Processing claims for payment, ensuring coverage validity and correct coding
• Examining claims for potential fraud or abuse
• Ensure compliance with internal policies, regulatory standards, and statutory requirements.
• Communicating with employees, beneficiaries, and internal stakeholders to answer queries and resolve issues
• Identify and upscale complex or suspicious claims for further review
• Calculate claim payouts and prepare settlement/decision letter
• Maintain detailed records of claim assessments and communications.
• Contribute to continuous improvement of claims processing procedures.

KEY Stakeholders

Internal: Claims Services, Distribution Services,
External: Network Partners, Clients, Distributors

Experience

• Proven experience in processing life insurance of individual and group/partnership claims
• In-depth knowledge of life insurance claims processes and terminology.
• Excellent communication, interpersonal and negotiation skills to liaise with internal and external stakeholders involved in the claims process.
• Strong understanding of data privacy, confidentiality, and fraud detection in individual or partner-sourced claims, compliance standards in the insurance sector, and regulatory requirements

Qualifications

• A bachelor’s/college degree. Paramedical course is preferred but not required.
• Certification in insurance (e.g., CPCU, LOMA) is a plus.
• At least 3 years experience in processing life claims, partnership management, or medical or forensic investigations related to claims.
• Strong computer literacy, especially with MS Office applications
• Communication Skills: Excellent verbal and written communication skills with ability to effectively articulate policy terms and conditions, and claims decision.
• Problem Solving Abilities: Strong analytical and problem-solving skills to identify claim processing gaps and recommend effective solutions for implementation.
• Knowledge of relevant regulations and compliance standards in the insurance sector including data privacy, anti-bribery and corruption laws.

At AXA, each person matters. We perform at our best knowing the positive impact we make as valuable partners for our customers and the communities we belong to.