Senior Professional Claims Operations

QBE Group Shared Services Centre; Cebu City; On-site; PHP 201,000 - 279,000; Full time

Job summary

QBE Group Shared Services Centre in Cebu City, Philippines seeks a dedicated claims handler responsible for end-to-end claim management, decision making on outcomes, and proactive customer interactions throughout the claims lifecycle. You will coordinate with suppliers and assessors, establish reserves, process payments, and ensure compliance with governance standards and SLAs.

The role requires a Bachelor's degree, strong English communication, and proficiency with Microsoft Office, with a

Qualifications

• Bachelor's Degree or equivalent combination of education and relevant work experience (per HTML).
• No specific experience required (per HTML).
• Strong customer service orientation (per HTML).
• Proficiency in Microsoft Office and related business tools (per HTML).
• Excellent verbal and written communication in English (per HTML).
• Case management experience or skills preferred (per HTML).

Responsibilities

• Manage claims end-to-end in accordance with the Claims Manual and governance standards (per HTML).
• Communicate with customers throughout the claims lifecycle (per HTML).
• Coordinate with suppliers and assessors to facilitate timely claim resolution (per HTML).
• Establish claim reserves and process payments within delegated authority (per HTML).
• Identify settlement strategies to achieve optimal outcomes (per HTML).
• Support risk management with insights and trend analysis (per HTML).
• Ensure compliance with regulatory requirements and governance standards (per HTML).

Skills

Customer service

English communication

Analytical thinking

Negotiation

Problem solving

Case management

Education

Bachelor's Degree

Tools

Microsoft Office

Job description

Primary Details

Time Type: Full time Worker Type: Employee

This role is responsible for end-to-end claim management. This includes making decisions on claim outcomes, declining claims, customer interaction (inbound and outbound), supplier coordination, raising payments to suppliers, and claim finalization. This role is also responsible for keeping portfolios compliant with measured SLAs.

Primary Responsibilities

• Manage claims end-to-end in accordance with the Claims Manual, Delegated Trading Protocols (DTPs), GSSC policies, relevant legislation, and regulatory requirements.
• Ensure compliance with delegated authority limits and all applicable governance standards.
• Maintain effective, professional, and proactive communication with customers throughout the claims lifecycle.
• Coordinate effectively with suppliers, assessors, and other stakeholders to facilitate timely claim resolution.
• Accurately establish claim reserves and ensure timely updates based on assessor reports and claim developments.
• Process payments within delegated authority limits and in accordance with company procedures.
• Interpret policy coverage and determine claim eligibility. Communicate claim acceptance or declinature decisions promptly and escalate issues for appropriate review or endorsement when required.
• Identify and implement the most appropriate settlement strategy to achieve optimal customer and commercial outcomes.
• Detect suspicious or potentially fraudulent claims in line with QBE fraud indicators and refer such cases to the Fraud Investigations Team.
• Identify and pursue recovery opportunities to minimize claim costs and maximize recoveries.
• Provide claims insights, feedback, and trend analysis to Underwriting and Risk teams to support business decision-making and risk management activities.
• Provide feedback to Underwriting regarding policy information, risk considerations, or claim-related insights that should be noted at policy renewal.
• Complete document uploads, claim registrations, and allocation activities to ensure claims and related documentation are routed to the appropriate teams. (Claims Settlements)
• Apply effective settlement strategies and negotiation techniques to achieve KPI targets and deliver optimal commercial outcomes. (Claims Settlements)
• Review claim documentation to identify liability disputes and appropriately triage cases to the relevant Claims Officers. (Claims Settlements)
• Continuously seek opportunities to improve processes, policies, and procedures while remaining current with regulatory, compliance, and business requirements. (Claims Settlements)

Required Education

• Bachelor's Degree or an equivalent combination of education and relevant work experience.

Required Experience

• No specific experience required.

Preferred Competencies And Skills

• Strong customer service orientation.
• Proficiency in Microsoft Office applications and related business tools.
• Strong analytical, problem-solving, and negotiation skills.
• Excellent verbal and written communication skills in English.
• Case management experience or skills preferred.

Preferred Knowledge

• Basic knowledge of insurance principles and claims processes.
• Basic understanding of customer service practices and standards.

QBE Cultural DNA

Everything we do at QBE is underpinned by our Cultural DNA, which reflects the behaviors and values that drive our success. Employees are expected to exemplify and promote the following cultural elements:

• We are customer-focused.
• We are technical experts.
• We are inclusive.
• We are fast-paced.
• We are courageous.
• We are accountable.
• We are a team.

All employees are expected to comply with QBE's Code of Ethics and Conduct and apply sound risk management practices in the performance of their duties.

US Only – Disclaimer

To successfully perform this role, an individual must be able to carry out the essential job responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Global Disclaimer

The duties outlined in this job description are not intended to be exhaustive and do not limit the assignment of additional responsibilities. Employees may be required to undertake duties outside their normal responsibilities as business needs arise.

QBE's Code of Ethics and Conduct outlines our responsibilities to our customers, colleagues, suppliers, communities, shareholders, and governments. It provides clear guidance to support ethical decision-making and sound professional judgment.

Skills

Analytical Thinking, Claims Administration, Claims Processing, Claims Resolution, Communication, Critical Thinking, Customer Service, Customer Value Management, Financial Advising, Intentional collaboration, Managing performance, Process Compliance, Process Improvements, Risk Management, Stakeholder Management

Equal Employment Opportunity

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.