FWD Group

Finance / FinServ

SeniorClaimsSpecialist

Philippines FULL TIME
The Brief

“Senior Claims Specialist at FWD Group. Skills: Claims assessment, Policy interpretation, Complex claims handling, Regulatory standards adherence, Customer experience delivery. Perform detailed assessment of complex, high-value, or sensitive claims. Manage assigned claim cases to ensure timely progression and adherence to target turnaround times (TATs) and internal service level agreements”

What You'll Achieve.

Accurate, timely, and contract-based assessment of insurance claims; Delivery of a positive customer experience; Objective claim decisions; Adherence to policy provisions; Timely progression of assigned claim cases; Adherence to target turnaround times (TATs); Adherence to internal service level agreements; Uplift claims quality and consistency

Industry & Context.

Finance / FinServ
Problems you'll solve

Assessment of complex, high-value, or sensitive claims; Resolution of escalated cases; Resolution of potential customer complaints; Assessment of exception cases

What They're Looking For.

Must Have

Experience with policy interpretation, Experience with claims standards, Experience with complex claims handling

Nice to Have

Subject-matter expert on policy interpretation, Subject-matter expert on claims standards, Subject-matter expert on complex claims handling

What You'll Do.

Perform detailed assessment of complex

Manage assigned claim cases to ensure timely progression and adherence to target turnaround times (TATs) and internal service level agreements

Recommend claim outcomes and escalate cases requiring higher authority

Support resolution of escalated cases or potential customer complaints

Ensure proper application of non-forfeiture provisions

and policy conditions

Validate claim documentation

and investigative findings

Act as a subject-matter expert on policy interpretation

and complex claims handling

Support onboarding and technical training of new Claims team members

Provide guidance and technical coaching to Claims Ambassadors and Analysts

Participate in or co-lead claims-related projects and initiatives

Assist in the preparation of administrative

and statistical reports

Support User Acceptance Testing (UAT) and implementation of system enhancements

or claims workflow changes

How You'll Work.

Team & Collaboration

Cross-functional collaboration; Escalate cases to Claims Committee, Underwriting, Medical, Legal, or Finance; Provide technical justifications and decision rationale to Claims Ambassadors for customer communication; Provide guidance and technical coaching to Claims Ambassadors and Analysts

Communication Scope

Customer communication; Technical justifications; Decision rationale

Process & Methodology

Process improvements, Risk controls, Efficiency enhancements, Claims-related projects and initiatives

Free ATS check

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