General Description:
The Head of Claims is responsible for the strategic and effective management of the Claims function, encompassing Individual Insurance Claims, Group Life & Health Claims, and Pre-assessment teams. The incumbent leads the Claims function’s contribution to the Claims Transformation project by defining the Claims Target Operating Model, articulating future-state requirements, shaping end-to-end workflow design, driving change management, and ensuring alignment with business priorities, operational objectives, and customer experience outcomes. This position reports directly to the Chief Operations Officer, Hong Kong & Macau.
Responsibilities:
Claims Experience Delivery
Lead the Claims team’s participation in the Claims Transformation project by defining future-state processes and workflow requirements
Provide expert input on claims operations, digitization, Straight Through Processing, and assessment practices to shape the design of the Claims Target Operating Model
Partner with Operations Transformation, the Claims Product Owner, IT, and cross-functional teams to co-design solutions and system capabilities
Represent Claims in system development and testing to ensure functionality, data accuracy, and operational usability
Drive change management, team readiness, and adoption of new processes and technologies
Define and monitor key metrics and drive continuous improvement initiatives
Claims Risk Management
Work with the Claims Risk Manager and Chief Medical Officer to implement a customer-centric, business-value-driven Claims Assessment Philosophy aligned with the company’s risk appetite, while safeguarding reputation and profitability
Work with the Claims Risk Manager and Chief Medical Officer to ensure the company’s claims practices remain market competitive
Ensure consistency and integrity in claims assessment approaches and decisions across the team
Ensure compliance with corporate and regulatory guidelines
Ensure claims audits are completed in accordance with corporate requirements
Pre-assessment Management
Oversee the Pre-assessment team to deliver timely, consistent support to distribution channels, customers, and internal stakeholders
Ensure pre-assessment practices align with claims philosophy, product provisions, underwriting considerations, and corporate guidelines
Monitor service quality, turnaround time, and case consistency to support effective claims experience delivery
Distribution Channel Management
Maintain effective two-way relationships with distribution channels to gather market feedback on claims practices, processes, and service support
Train and guide distribution channels to understand and support the company’s claims philosophy
New Product Development/Claims Initiatives
Ensure smooth rollout of product and claims initiatives in alignment with corporate policies and guidelines
Collaborate with relevant stakeholders to develop claims assessment practices for new products and claims initiatives
Ensure effective and timely training of claims assessors for new or revised guidelines
Team Development
Build a high-performing team and develop a sustainable succession plan
Demonstrate leadership capability to develop an engaged, client-centric team that delivers sustainable business, operational, employee, and customer outcomes
Strengthen talent development, performance management, and team effectiveness to support business continuity and succession objectives
Accountabilities (Individual / Shared):
Individual Accountabilities:
Claims Performance Management and Operations
Claims Risk Management
Customer and Claims Experience
Team Leadership and Talent Development
Key Shared Accountabilities:
Claims Transformation and Digital Enablement
Claims Experience Delivery
New Product Development and Claims Initiatives
Distribution Channel Management
Customer Experience and Complaint Management
Business Continuity and Operational Resilience
Knowledge/Skills/Competencies/Education:
Degree in Insurance,…