Officer, 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

PURPOSE
• Perform life, medical and critical illness claims assessment and service support activities in CTC under Hong Kong claims governance.
• Apply policy provisions, approved claims guidelines and delegated authority to deliver accurate, timely and compliant claim outcomes while supporting consistent service quality across the offshore operation.

PURPOSE

• Perform life, medical and critical illness claims assessment and service support activities in CTC under Hong Kong claims governance.
• Apply policy provisions, approved claims guidelines and delegated authority to deliver accurate, timely and compliant claim outcomes while supporting consistent service quality across the offshore operation.

KEY ACCOUNTABILITIES

• Assess life, medical and critical illness claims and determine claim outcomes within delegated authority, policy provisions and approved guidelines.
• Review claim forms, medical evidence and supporting documents; identify missing or inconsistent information and follow up on additional requirements needed for assessment.
• Process assigned claims within agreed service levels and turnaround standards while maintaining accurate records, clear rationale and complete documentation.
• Escalate complex, exceptional, suspicious, high-risk or out-of-authority cases to the Claims Team Manager or designated Hong Kong claims authority.
• Handle claims enquiries from policyholders, claimants, distribution and internal service channels, providing clear status and requirement explanations within approved protocols.
• Comply with claims governance, confidentiality, fraud risk controls, AML/CTF requirements, information security standards and applicable operating procedures.
• Identify recurring claim, workflow or system issues and contribute observations and data to quality improvement, training and approved enhancement initiatives.
• Support knowledge sharing, calibration and ad hoc claims assignments as directed by the line manager.

KEY PERFORMANCE INDICATORS

• Claims turnaround time and achievement of agreed SLA.
• Claim assessment accuracy, consistency and documentation quality.
• Compliance with delegated authority, policy provisions and control requirements.
• Productivity and timely management of assigned claim inventory.
• Quality of enquiry handling and stakeholder service.

EXTERNAL & INTERNAL CONTACTS

• CTC Claims Team Manager and claims colleagues.
• Hong Kong Claims, Customer Engagement, Distribution, Operations, Underwriting and relevant risk, compliance or legal partners.
• Policyholders, claimants, approved medical providers and other service-provider contacts where required by established process.

DECISION MAKING

• Make claim assessments and decisions within delegated authority, policy provisions and approved guidelines.
• Determine routine additional evidence or claim requirements in accordance with established claims rules.
• Prioritise assigned workload to meet service and quality requirements.
• Identify and escalate cases involving complexity, exceptions, suspected fraud, heightened risk or authority limits.

QUALIFICATIONS / EXPERIENCE

• University graduate or above; professional insurance or claims qualification such as FLMI, ALHC or equivalent is preferred.
• Minimum 3 years of relevant experience in life and/or medical claims operations.
• Practical experience in claim assessment, evidence review and claim decision-making.

KNOWLEDGE & TECHNICAL SKILLS

• Sound knowledge of life, medical and critical illness claims principles, policy provisions, evidence evaluation and claim assessment.
• Working knowledge of delegated authority, case escalation, fraud indicators, confidentiality, AML/CTF and relevant operational controls.
• Strong analytical and problem-solving skills, with the ability to interpret medical and non-medical information.
• Good written and spoken English and Chinese.
• Proficiency in Microsoft Word, Excel and PowerPoint and ability to work with claims workflow systems.

COMPETENCIES

• Sound professional judgment with clear accountability for decisions within assigned authority.
• Detail-oriented, quality-focused and risk-aware.
• Able to manage multiple priorities and work effectively under pressure in a changing environment.
• Effective communicator and collaborative team player across locations and functions.
• Self-motivated, disciplined and receptive to technical feedback and continuous learning.
• Customer and service oriented while maintaining claims independence and control standards.