Claims Specialist

FWD Group Management Holdings Limited; Philippines; On-site; PHP 300,000 - 540,000; Full time

Job summary

FWD Group is seeking a Claims Specialist in the Philippines to serve as the first line of communication for claimants from notification to final decision. The role involves coordinating with distributors and internal teams to ensure accurate, timely processing and clear communication of outcomes.

You will manage Customer Connect Services for claims, handle denial/appeal cases, and support VIP claim coordination while upholding service levels and compliance across operations.

Responsibilities

• Manage the delivery of Customer Connect Services related to Claims operations, including email, SMS, and mobile access support.
• Facilitate handling of denial and appeal cases and represent claims on escalated cases to distributors and claimants.
• Coordinate VIP claims and ensure timely completion of requirements with clear status communication to stakeholders.
• Implement monitoring/control measures to ensure service quality and SLA compliance.
• Assist in documentation, reporting, and ad hoc projects including UAT for Claims enhancements.

Tools

OWB System

Job description

Claims Specialist

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 ReportingPrepare 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 StandardizationEnforcing standardized subject line protocols to enhance tracking, prioritization and categorization of claims, reducing risk of missed or misrouted communications.
• OWB System Support and Data ManagementEnsure 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 escalation 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.

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