Assistant Manager, Claims

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 Takaful Berhad

FWD Takaful Berhad (“FWD Takaful”) is a takaful provider in Malaysia that offers family takaful services. FWD Takaful is licensed under the Islamic Financial Services Act 2013 and is regulated by Bank Negara Malaysia. FWD Takaful is a takaful business unit of FWD Group.

Visit https://www.fwd.com.my

Join us

We’re proud to be a company that encourages and nurtures fearless innovation in achieving our vision of changing the way people feel about takaful. Our teams come from a wide variety of industries and backgrounds because we value developing a truly diverse pool of talent that brings different perspectives and experiences. Our values – committed, innovative, proactive, open, and caring – define who we are and what we do as we work together to bring our vision to life, every single day.

KEY ACCOUNTABILITIES 

• Handle assigned claims from receipt to closure: validate documentation, assess liability/coverage, calculate payable amounts, and process settlements within the delegated authority limits.
• Conduct deeper reviews for complex, early claim, high-cost, or borderline claims; prepare case summaries and recommendations for escalations.
• Ensure compliance with claims procedures, SLAs, regulatory standards, and audit expectations.
• Identify potential fraud indicators and initiate appropriate investigative steps and referrals.
• Communicate decisions and rationales clearly to customers, providers, intermediaries, and internal stakeholders.
• Maintain accurate case records and documentation for auditability and analytics.
• Contribute to process improvements (e.g., checklist updates, rules tuning, digital workflow enhancements).
• Support training/peer coaching on technical topics, guidelines, and systems (without formal team supervision).
• Assist in claims report management, including data compilation, validation, and preliminary analysis for internal and external reporting.

QUALIFICATIONS / EXPERIENCE

• Bachelor’s degree in insurance, Business, Finance, Nursing/Medical Sciences, or related field (or equivalent experience).
• 3–6 years of hands-on claims processing experience (health/medical, life/CI, or other relevant lines).
• Exposure to complex claims assessment, medical report interpretation, and provider interactions.
• Experience working with claims workflow systems and TPAs is an advantage.

KNOWLEDGE & TECHNICAL SKILLS

• Solid understanding of policy wordings for Health/Medical and Life/Critical Illness (CI) product, including coverage triggers, exclusions, pre-existing conditions, waiting periods, coordination of benefits, sub-limits, and reimbursement rules.
• Clear written and verbal communication for explaining claim decisions to customers and providers.
• Ability to interpret medical documentation (discharge summaries, diagnostic tests, ICD coding) and assess medical necessity for both health and Life/CI claims.
• Familiarity with fraud indicators and investigation protocols.
• Proficiency in claims systems, case management tools, and MS Office (Excel/Word/Outlook).
• Working knowledge of regulatory and audit requirements applicable to claims (company policies, market conduct, privacy/data protection).
• Analytical skills for trend detection; clear written rationale for claim determinations.