Senior Expert, Claims (Insurance Project)

Job Description

Job Purpose

The Senior Expert, Claims, will play a critical role in setting up and managing the claims function for a newly established life insurance company. This role is responsible for developing claims processes, defining Standard Operating Procedures (SOPs), collaborating with IT to implement claims management systems, working with reinsurers on claims policies, and establishing strong partnerships with third-party service providers such as medical panels and claims investigators. The Senior Expert, Claims, will also work closely with Techcombank to integrate data insights and ensure a seamless claims experience for customers.

Key Responsibilities

Claims Process Setup & SOP Development

- Develop and implement Standard Operating Procedures (SOPs) for claims processing, ensuring efficiency and compliance.

- Design end-to-end claims workflows, from claim submission to assessment, approval, and payment.

- Ensure alignment of claims processes with regulatory requirements and industry best practices.

Collaboration with IT & Digital Transformation

- Define business requirements for IT teams to implement a digital claims management system.

- Work with IT and digital teams to integrate claims automation tools and AI-driven claims assessment models.

- Ensure seamless integration of claims processing with policy administration and customer service platforms.

Claims Risk Management & Reinsurance Coordination

- Collaborate with reinsurance companies to define claims handling guidelines and facultative claims assessment.

- Establish governance frameworks for claims risk monitoring and fraud detection.

- Work closely with actuarial and underwriting teams to ensure claims trends inform future risk assessment strategies.

Stakeholder Engagement & Collaboration with Techcombank

- Engage with Techcombank’s distribution and risk teams to develop claims service standards that meet customer expectations.

- Work on data integration between Techcombank and the insurance company to ensure smooth claims verification and settlement.

- Provide training and support to distribution teams on claims procedures and fraud detection measures.

Collaboration with Third-Party Service Providers

- Establish and manage relationships with third-party medical panels, hospitals, clinics, and claims investigation firms.

- Negotiate and monitor service level agreements (SLAs) with external partners to ensure high-quality claims services.

- Ensure that external medical evaluations and claims assessments support the company’s risk management objectives.

Customer-Centric Claims Experience

- Develop a customer-friendly claims process that balances risk management with a smooth and transparent experience.

- Implement digital solutions to allow self-service claims submission, tracking, and updates for customers.

- Continuously monitor claims turnaround times and propose improvements to enhance customer satisfaction.

Performance Monitoring & Continuous Improvement

- Define and track key performance indicators (KPIs) for claims processing efficiency, fraud detection, and settlement ratios.

- Analyze claims data to identify trends, potential risks, and areas for process optimization.

- Ensure that claims policies evolve based on claims experience and market trends.

Job Requirement

Qualifications and Experience

Education

- Bachelor's or Master’s degree in Business Administration, Finance, Insurance, Law, or a related field.

Experience

- Minimum of 7-10 years of experience in life insurance claims management, including experience in setting up claims processes and guidelines.

- Experience working with reinsurance companies on claims policies and facultative claims support.

- Proven track record in digital transformation of claims operations, including automation and system implementation.

- Strong experience in managing third-party claims service providers, including medical panels and claims investigators.

- Exposure to bancassurance operations and an understanding of financial data integration to support claims processing.

Skills & Competencies

- Claims Management & Risk Assessment – Expertise in designing claims policies and handling complex claims cases.

- Regulatory & Compliance Knowledge – Strong understanding of Vietnam’s insurance claims regulations and legal frameworks.

- IT & Data Integration – Experience in working with IT teams to implement claims automation and digital claims processing.

- Reinsurance & Fraud Prevention – Ability to collaborate with reinsurers to ensure risk-appropriate claims handling and fraud mitigation.

- Stakeholder & Third-Party Management – Strong skills in engaging with Techcombank, reinsurers, and medical service providers.

- Customer-Centric Approach – Ability to balance efficient risk management with an excellent customer experience in claims processing.

Personal Attributes

- Detail-Oriented & Analytical – Strong ability to assess claims cases with precision and accuracy.

- Proactive & Strategic Thinker – Capable of setting up claims processes from scratch while anticipating future challenges.

- Customer-Focused – Ensures claims operations are transparent, efficient, and customer-friendly.

- Leadership & Initiative – Capable of driving claims transformation and operational setup in a startup environment.

- Collaborative & Solution-Oriented – Works effectively with internal teams, reinsurers, and third-party service providers.