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

- Lead and oversee the end-to-end Health Claims operations, including hospitalization, surgical, outpatient, medical reimbursement, and group medical claims.
- Ensure claims are assessed fairly, consistently, and in accordance with policy contracts, Claims SOPs, medical guidelines, and regulatory requirements.
- Monitor and improve claims turnaround time (TAT), productivity, accuracy, and customer satisfaction.
- Lead claims digitalisation initiatives and system enhancements, including business requirement gathering, UAT, implementation, and post-production monitoring.
- Collaborate with IT, product, underwriting, and external vendors to enhance claims capabilities and straight-through processing (STP).
- Ensure compliance with internal policies, Claims SOPs, BNM regulatory requirements, Takaful/Insurance standards, and FWD Group governance requirements.
- Maintain effective controls, audit readiness, and proper documentation for all claims decisions and operational processes.
- Lead and manage Third Party Administrator (TPA) relationships to ensure service quality, turnaround time, operational efficiency, and contractual compliance.
- Conduct regular performance reviews, service level monitoring, and governance discussions with TPAs.
- Lead claims reporting and analytics to identify trends, operational issues, leakage risks, and improvement opportunities.
- Provide management reporting and insights to support strategic decision-making.
- Lead, coach, develop, and motivate the Claims team to enhance technical competency, productivity, and customer-centric culture.
- Support succession planning, capability building, and performance management initiatives.

QUALIFICATIONS / EXPERIENCE

- Bachelor’s degree in insurance, Medicine, Nursing, Biomedical Science, Pharmacy, Health Sciences, Business Administration, or related disciplines.
- Minimum 7-10 years of experience in Health Claims operations.
- Minimum 3 years of people management experience.
- Experience managing TPAs, healthcare providers, and vendor performance.
- Experience in claims transformation, process improvement, or system implementation projects is an added advantage.
- Exposure to medical claims cost management and healthcare ecosystem practices is preferred
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KNOWLEDGE & TECHNICAL SKILLS

- Strong knowledge of medical and health insurance claims assessment.
- Good understanding of insurance and takaful products.
- Strong knowledge of healthcare billing, medical procedures, and hospital claims administration.
- Knowledge of BNM regulations, industry guidelines, and claims governance requirements.
- Experience with claims administration systems and workflow management tools.
- Data analytics, reporting, and dashboard interpretation skills.
- Project management and process improvement capabilities