Senior Claims Specialist, Complex & High-Value

fwd; Philippines; Remote; PHP 250,000 - 450,000; Full time

Job summary

FWD Life Philippines seeks a skilled Claims Specialist to perform detailed assessment of complex, high-value claims, ensuring decisions follow policy provisions and regulatory standards. You will manage cases to meet turnaround times, collaborate with underwriting, medical, legal, and finance, and contribute to increasing claims quality through coaching and audits.

This role supports onboarding, training, and reporting, with opportunities to lead process improvements and participate in system

Responsibilities

• Perform detailed assessment of complex, high-value, or sensitive claims, 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.
• 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.

Job description

FWD Life Philippines seeks a skilled Claims Specialist to perform detailed assessment of complex, high-value claims, ensuring decisions follow policy provisions and regulatory standards. You will manage cases to meet turnaround times, collaborate with underwriting, medical, legal, and finance, and contribute to increasing claims quality through coaching and audits.

This role supports onboarding, training, and reporting, with opportunities to lead process improvements and participate in system