Claims Officer (For Pooling)

AXA; Philippines; On-site; PHP 350,000 - 650,000; Full time

Job summary

AXA Philippines is seeking a Life Claims Officer to review and assess individual life insurance claims, ensuring accurate settlement and timely decisions. You will collaborate with internal teams and external partners to verify information and code payments correctly.

The role requires experience in processing life claims, strong communication, and adherence to privacy and regulatory standards. Join AXA Philippines to contribute to trusted insurance solutions and customer service excellence.

Qualifications

• Bachelor’s/college degree; Paramedical preferred but not required.
• Insurance certifications (e.g., CPCU, LOMA) a plus.
• 3+ years experience in processing life claims.
• Strong MS Office skills and data privacy awareness.
• Excellent written and verbal communication.

Responsibilities

• Review life claims for completeness and accuracy.
• Assess claims against policy terms, conditions, and exclusions.
• Process payments with correct coding.
• Detect potential fraud or abuse.
• Communicate with stakeholders to resolve queries.
• Maintain claim records and support continuous improvement.

Skills

Life claims processing

Claims review

Communication skills

Data privacy

Education

Bachelor’s degree

Insurance certifications (CPCU, LOMA)

Tools

MS Office

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 claimssubmittedby 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 escape 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 inprocessinglifeinsurance of individual and group/partnership claims
• In-depth knowledge oflifeinsurance 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/collegedegree.Paramedical courseis preferredbut notrequired.
• Certification in insurance (e.g., CPCU, LOMA) is a plus.
• At least 3yearsexperienceinprocessing lifeclaims, 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 skillswithability toeffectively articulate policy terms and conditions, and claims decision.
• Problem Solving Abilities:Strong analytical andproblem-solvingskills toidentifyclaimprocessing gapsandrecommend effective solutionsfor implementation.
• Knowledge of relevant regulations and compliance standards in the insurance sector including data privacy, anti-briberyand 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.If you want to know more about the other career opportunities at AXA Philippines, please follow this link:https://careers.axa.com/axa-entities/axa-philippines