Claims Specialist

FWD Insurance; Philippines; On-site; PHP 335,000 - 670,000; Full time

Job summary

FWD Life Philippines is seeking a Claims Operations professional to manage customer-connect services for claims, coordinate VIP submissions and ensure timely, accurate communication of decisions. The role also covers complaints handling, VOC monitoring and supporting process improvements within the Claims team.

The position emphasizes adherence to SLA, data accuracy in OWB, and collaboration with distributors and claimants to deliver a positive customer experience.

Qualifications

• Experience in claims operations or customer service is advantageous.
• Strong written and verbal communication skills.

Responsibilities

• Manage the delivery of Customer Connect Services related to Claims operations, including the claims connect email, SMS and mobile access support.
• Facilitate handling of denial and appeal cases; represent claims on escalated cases and communicate with distributors and claimants.
• Coordinate VIP claims submissions; ensure timely completion, accurate status tracking and clear final decision communication to stakeholders.
• Implement monitoring and control measures to ensure service quality and SLA compliance; perform daily monitoring and reporting.
• Prepare daily reports on answered emails, claims submissions, compliance requirements and follow-ups; ensure timely responses and adherence to standards.
• Standardize email subject lines to improve tracking and prioritization of claims.
• Support OWB data entry and upload of claim documents; assist claims analysts to expedite handling and maintain compliance.
• Manage customer service recovery and resolution for all claims-related feedback and complaints within turnaround time; escalate when needed.
• Monitor VOC results; represent Claims team in CX-related initiatives.
• Provide ad hoc documentation and statistical reports; participate in UAT and process improvements; support ongoing business needs.

Job description

Job Description:

About FWD Group

FWD Group (1828.HK) is a pan-Asian life and health insurance business that serves approximately 40 million customers across 10 markets, including BRI Life in Indonesia. FWD’s customer-led and tech-enabled approach aims to deliver innovative propositions, easy-to-understand products and a simpler insurance experience. Established in 2013, the company operates in some of the fastest-growing insurance markets in the world with a vision of changing the way people feel about insurance. FWD Group is listed on the main board of the Hong Kong Stock Exchange under the stock code 1828.

For more information, please visit www.fwd.com

About FWD Life Philippines

FWD Life Insurance Corporation (FWD Life Philippines) launched its commercial operations in September 2014. As of end-2022, FWD Life Philippines ranks 3rd and 6th in terms of Paid-up Capital(1) and New Business Annual Premium Equivalent(2), respectively.

For more information, please visit fwd.com.ph.

1 www.insurance.gov.ph > Statistics > Life > 2022 > Based on Paid-Up Capital

2 www.insurance.gov.ph > Statistics > Life > 2022 > Based on New Business Annual Premium Equivalent

To deliver the desired customer experience overall management of positive claims experience journey for claimants and beneficiaries. First line of communication for Claims analyst, Distribution team, and Beneficiaries/claimants from claim notification to claim decision notice.

1. Service Functions.

Manage the delivery of Customer Connect Services related to Claims operations, including but not limited to the claims connect email, with SMS and mobile access support for the unit.

Facilitate the effective handling of denial and appeal cases and will represent claims on escalated claim case and other communication requirement to both distributors and claimants.

Manage efficiently all VIP claims coordination and submission process, ensuring timely completion of claim requirements, accurate status tracking and clear communication of final decisions to stakeholders.

Implement and maintain robust monitoring and control measures to ensure service quality and compliance, including:

• Daily Monitoring and Reporting

Prepare and maintain daily reports covering answered emails, claims submissions, compliance requirements and follow-ups to ensure timely communication responses and adherence to service standards.

• Email Subject line Standardization

Enforcing standardized subject line protocols to enhance tracking, prioritization and categorization of claims, reducing risk of missed or misrouted communications.

• OWB System Support and Data Management

Ensure timely and accurate data entry and uploading of clam documents in OWB, directly supporting Claims Analyst in expedite claim handling, improving workflow efficiency and maintaining compliance with Service Level Agreement (SLA).

2. Claims Complaint Coordinator

Manage customer service recovery and resolution for all claims-related customer feedback and complaints, ensuring cases are addressed ad closed within turnaround time (TAT)

Identify and elevate potential or complex claims complaints to the Head of Claims for review and decision, ensuing proper governance, risk management and alignment with policy provision.

3. Claims VOC Coordinator

Monitor VOC results and feedback with Claims Team. Will represent Claims team in CX related claim initiatives

4. Documentation and Special Projects.

Provide support on an ad hoc basis in preparation of administrative and statistical reports, ensuring accuracy and timely submission.

Participate in special projects and initiatives, including user Acceptance Testing (UAT) for Claims-related enhancements an process improvements, to ensure system changes meet operational and service requirements.

Performs other duties and responsibilities as assigned to support claims operations, continuous improvement initiatives and overall business requirements

Privacy Notice

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FWD has partnered with Talocity Instasolutions Private Limited (“Talocity”) to manage the initial filtering of candidate’s profiles through video interviews, social profile mapping, and video analytics using artificial intelligence engine that is offered within the Talocity platform. The platform evaluates the candidate on the five well-known dimensions as per OCEAN Personality Model that influence occupational success and help understand workplace behavior. For more information, please refer to Talocity Privacy Policy.

Requirements: