Sr. Assoc. Director - A&H Claims Payment

Job Summary

The Senior Associate Director, A&H Claims Payment is responsible for leading the end-to-end claims reimbursement operation to ensure excellent service delivery, operational efficiency, and compliance with company policies and regulatory requirements. The role drives performance excellence through effective team leadership, continuous process improvement, and proactive management of claims backlogs and complex cases.

The position oversees claims assessment and payment activities, ensuring accurate and timely claim decisions while maintaining high standards of customer experience. In addition, the role collaborates closely with internal stakeholders, regulatory bodies, and legal partners to support complaint resolution, litigation cases, and business improvement initiatives.

Key Responsibilities

1. Claims Payment Management

- Lead and manage the A&H Claims Payment team to ensure effective handling of reimbursement claims.
- Provide guidance, coaching, and technical support to team members in claim assessment and decision-making.
- Review and approve claims within delegated authority limits.
- Oversee decisions related to claim rejection, requests for additional information, and referrals for further investigation.
- Ensure proper documentation and issuance of claim memos and system updates to support downstream operational processes.
- Monitor pending claims and backlog cases, taking appropriate actions to maintain agreed service levels.
- Manage complex and high-impact cases requiring escalation to the Claims Committee, COO, or CEO in accordance with approval authority guidelines.
- Ensure claim decisions are accurate, compliant, and aligned with company policies, underwriting conditions, and regulatory requirements.
- Drive operational excellence initiatives to improve turnaround time, productivity, quality, and customer satisfaction.

2. Team Leadership & Capability Development

- Lead, motivate, and develop a high-performing claims reimbursement team.
- Establish performance objectives and monitor individual and team performance against defined KPIs.
- Foster a culture of accountability, collaboration, continuous learning, and customer-centricity.
- Support succession planning and capability development across the team.

3. Operational Reporting & Performance Management

- Oversee the preparation and analysis of daily, weekly, and monthly operational reports.
- Monitor claim volumes, turnaround time, service quality, productivity, and key operational indicators.
- Ensure management reports are delivered accurately and on time.
- Provide insights and recommendations to management to support business decision-making and continuous improvement.

4. Regulatory Complaint & Customer Escalation Support

- Partner with Claims Relations and relevant stakeholders to manage and resolve customer complaints and escalated cases.
- Ensure timely and accurate information is provided to support complaint investigations and regulatory inquiries.
- Lead team efforts in preparing documentation and responses for regulatory reviews and customer advocacy cases.

5. Legal & Litigation Support

- Collaborate with Claims Relations, Legal Department, and external counsel in handling litigation and court-related cases.
- Provide claim analysis, investigation findings, and supporting documentation for legal proceedings.
- Represent the company, when required, alongside Legal representatives in court hearings and case discussions.
- Ensure proper governance, documentation, and compliance throughout litigation processes.

Qualifications & Experience

- Bachelor's or master’s degree in business administration, Nursing, Medical Technology, Health Sciences, Insurance, or related disciplines.
- Minimum 5-8 years of experience in Claims Assessment, Claims Operations, or related functions within the insurance industry.
- Proven experience in leading teams and managing operational performance.
- Strong understanding of health and accident insurance products, claim assessment principles, and insurance regulations.
- Experience handling complex claims, customer escalations, regulatory complaints, and legal cases is preferred.
- Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage.

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges is what makes us a unique employer. We are united by a shared commitment: to put our customers first and at the centre of everything we do. Their needs inspire our thinking and guide our actions. Together, we can build an environment where everyone feels empowered and confident to explore, grow and shape a better future – for our customers and for the world around us. At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and where integrity, fairness, inclusion and trust are at the heart of our culture. We therefore welcome applications regardless of ethnicity or cultural Internal background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Join us. Let's care for tomorrow.