AVP, Claims Support

Key Responsibilities

Claims Processing & Decision Making

Assess and process Life & Health insurance claims within delegated authority and service standards

Ensure compliance with policy terms, claims guidelines, and standard operating procedures

Perform accurate benefit calculations, verify payee details, maintain adequate reserves, and ensure timely claim settlement

Monitor and review pending claims to ensure prompt closure

Identify unusual claim patterns or practices and recommend improvements to strengthen controls

Resolve processing issues and escalate complex cases when necessary

Stakeholder & Customer Engagement

Liaise with medical professionals, policyholders, claimants, and agents to gather required documentation and clarify information

Provide timely updates and insights to internal stakeholders

Service Excellence

Deliver clear, empathetic, and professional communication to all stakeholders

Ensure a smooth, transparent, and customer-focused claims experience

Process Standardization & Improvement

Support standardization of claims processes across markets

Identify opportunities to improve efficiency, simplify workflows, and enhance straight-through processing

Governance, Risk & Compliance

Adhere to internal policies and regulatory requirements

Maintain strong operational controls to mitigate financial, processing, and compliance risks

Identify risk areas and implement corrective actions proactively

Support audits, quality assurance activities, and compliance reviews

Maintain proper documentation and audit trails for all claims decisions



Requirements

Bachelor’s degree or professional certification in Insurance, Healthcare, or a related discipline

3–5 years of experience in Life and/or Health insurance claims processing

Strong in People Management

Strong knowledge of medical terminology, medical practices, and coding systems.

Solid understanding of insurance policy terms and claims assessment principles

Strong analytical and decision-making skills with the ability to interpret complex information

High attention to detail and ability to manage high volumes with accuracy

Excellent interpersonal and communication skills with a customer-focused mindset

Experience supporting multiple markets is an advantage

A collaborative team player with a proactive attitude and willingness to learn