Officer, Claims
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Before you apply
LocationChina - Guangzhou
Typefull-time
SeniorityMid
Company size1,001–5,000 people
PostedOct 8, 2026 · 4w ago
Verified live3d ago
At a glanceSummarised by Seekless from the posting.
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
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
Achieve claims turnaround time and SLA targets
Maintain claim assessment accuracy, consistency and documentation quality
Manage assigned claim inventory productively and on time
Provide quality enquiry handling and stakeholder service
Comply with claims governance, confidentiality, fraud risk controls, AML/CTF requirements, information security standards and applicable operating procedures
Comply with delegated authority, policy provisions and control requirements
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 the role
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.
Responsibilities
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
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CTC Claims Team Manager and claims colleagues.
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Hong Kong Claims, Customer Engagement, Distribution, Operations, Underwriting and relevant risk, compliance or legal partners.
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Policyholders, claimants, approved medical providers and other service-provider contacts where required by established process.
DECISION MAKING
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Make claim assessments and decisions within delegated authority, policy provisions and approved guidelines.
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Determine routine additional evidence or claim requirements in accordance with established claims rules.
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Prioritise assigned workload to meet service and quality requirements.
•
Identify and escalate cases involving complexity, exceptions, suspected fraud, heightened risk or authority limits.