Senior Claims Specialist

FWD Insurance; Philippines; On-site; PHP 600,000 - 900,000; Full time

Job summary

FWD Life Philippines is seeking an experienced Claims Analyst to join our team in the Philippines. You will perform detailed assessments of complex, high-value claims, ensuring decisions align with policy provisions and regulatory standards.

You will manage cases to meet turnaround times, escalate when necessary, and support training and process improvements to strengthen claims quality and efficiency. This role collaborates with cross-functional partners to ensure accurate documentation and

Responsibilities

• Assess complex, high-value claims for accuracy and regulatory compliance.
• Manage cases to meet target turnaround times and SLAs.
• Escalate to Claims Committee or other functions as needed.
• Provide technical justification to support customer communications.
• Ensure proper application of policy provisions and non-forfeiture rules.
• Support onboarding and training for new team members.
• Contribute to claims-related process improvements and reporting.

Job description

Job Description

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

Service Functions

• Perform detailed assessment of complex, high-value, or sensitive claims (e.g., contestability, non-disclosure, exclusions, medical complexity), ensuring decisions are aligned with policy provisions, underwriting disclosures, and regulatory standards.
• Manage assigned claim cases to ensure timely progression and adherence to target turnaround times (TATs) and internal service level agreements.
• Recommend claim outcomes and elevate cases requiring higher authority to the Claims Committee, Underwriting, Medical, Legal, or Finance, as appropriate.
• Support resolution of escalated cases or potential customer complaints by providing technical justifications and decision rationale to Claims Ambassadors for customer communication.
• Ensure proper application of non-forfeiture provisions, grace period rules, extensions, exclusions, and policy conditions, including assessment of exception cases subject to approval.
• Validate claim documentation, medical evidence, and investigative findings to ensure completeness, sufficiency, and audit readiness.
• Act as a subject-matter expert on policy interpretation, claims standards, and complex claims handling.

Documentation and Special Projects

• Support onboarding and technical training of new Claims team members, including process orientation, policy fundamentals, and claims assessment standards.
• Provide guidance and technical coaching to Claims Ambassadors and Analysts to uplift claims quality and consistency.
• Participate in or co-lead claims-related projects and initiatives, including process improvements, risk controls, and efficiency enhancements.
• Assist in the preparation of administrative, operational, and statistical reports, including support for audits, management reporting, and regulatory submissions.
• Support User Acceptance Testing (UAT) and implementation of system enhancements, digital initiatives, or claims workflow changes.
• Perform other duties as assigned to support operational requirements and business continuity.

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