Claims Operations Lead: Settlements, Quality & Compliance

Inova Care; Makati; On-site; PHP 600,000 - 1,000,000; Full time

Job summary

Inova Care in Makati, Philippines is seeking a skilled Claims Operations Leader to manage end-to-end claims processing—from intake and assessment to adjudication and settlement—and to drive accuracy, turnaround times, and customer satisfaction.

You will coach a claims team, review complex claims, ensure policy compliance, monitor trends and costs, and collaborate with Underwriting, Finance, Legal, and Customer Service to optimize processes and support audits.

Responsibilities

• Manage end-to-end claims operations, including claims intake, assessment, investigation, adjudication, and settlement.
• Lead, coach, and develop the claims team to achieve productivity, accuracy, turnaround time, and service-level targets.
• Review and approve complex, high-value, or escalated claims within delegated authority.
• Ensure claims decisions are consistent with policy terms, coverage, exclusions, and company guidelines.
• Monitor claims trends, loss ratios, reserves, settlements, and overall claims costs.
• Investigate questionable, unusual, or potentially fraudulent claims and coordinate with relevant departments when necessary.
• Liaise with policyholders, brokers, agents, adjusters, service providers, and other stakeholders to resolve claims-related concerns.
• Ensure compliance with insurance regulations, internal controls, audit requirements, and company policies.
• Identify process gaps and implement initiatives to improve claims efficiency, accuracy, and customer experience.
• Prepare regular management reports on claims volume, performance, costs, trends, and key operational metrics.
• Establish and monitor claims KPIs, SLAs, quality standards, and turnaround times.
• Collaborate with Underwriting, Finance, Legal, Risk, Customer Service, and other departments on claims-related matters.
• Support internal and external audits and ensure timely resolution of audit findings.
• Perform other duties related to claims operations and company objectives as assigned.

Job description

Inova Care in Makati, Philippines is seeking a skilled Claims Operations Leader to manage end-to-end claims processing—from intake and assessment to adjudication and settlement—and to drive accuracy, turnaround times, and customer satisfaction.

You will coach a claims team, review complex claims, ensure policy compliance, monitor trends and costs, and collaborate with Underwriting, Finance, Legal, and Customer Service to optimize processes and support audits.