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Head of Claims Management
Ref No.: 20-00961
Location: Hong Kong, Hong Kong

Accountabilities and Activities

  • Manage and oversee the operations of claims and case management department to meet operations, productivity, quality & control and services requirements
  • Establish proper procedures and policies to be utilized throughout the life cycle of claims resolution and pre-authorization process
  • To be responsible for strategic processing and payment / approval of claims and pre-authorization cases
  • Identify employee/team objectives, manage associated plans and provide guidance to subordinates in claims and case management team
  • Regularly analyse the workflow process of entire department in consideration of emerging technology, identifying opportunities to operate claims and case management organization more efficiently
  • Keep abreast of any changes to legislation and regulations which pertain to insurance claims and ensure company goals are met in conjunction with compliance of legal requirements
  • Address and resolve elevated customer complaints regarding claims and case management related issues
  • Review management reports and implement corrective actions identified
  • Prepare for and participate in audits and compliance review and ensure the operations procedure is in compliant to the set rules and regulations
  • Maintain open communication channel with other departments and management, including but not limited to Underwriting, Finance, People and IT teams
  • Keep the Operations and Business Transformation Director informed with reference to developments in claims and case management trend that substantially affect our business


To be considered for this role, you should ideally have

  • Bachelor degree or qualifications in medical professional
  • Minimum 10 years' solid experience and 7 years in leading people in claims or pre-authorization functions
  • Solid experience in health insurance claims management
  • Background in medical or relevant transferable skills and knowledge from other financial services industries is preferred
  • Multi-tasking, with strong sense for looking at innovative means to improve operations efficiency and customer experience
  • Excellent leadership, interpersonal and influencing skills
  • Strong analytical, problem solving and decision making skills
  • To be customer focus and committed to deliver high quality services
  • High levels of integrity, trust and independency
  • Fluency in written and spoken English and Cantonese