Head of Claims

The Head of Claims is responsible for the strategic and effective management of the Claims function, encompassing Individual Insurance Claims, Group Life & Health Claims, and Pre-assessment teams.

The incumbent leads the Claims function’s contribution to the Claims Transformation project by defining the Claims Target Operating Model, articulating future-state requirements, shaping end-to-end workflow design, driving change management, and ensuring alignment with business priorities, operational objectives, and customer experience outcomes.

Responsibilities:

Claims Experience Delivery

• Lead the Claims team’s participation in the Claims Transformation project by defining future-state processes and workflow requirements
• Provide expert input on claims operations, digitization, Straight Through Processing, and assessment practices to shape the design of the Claims Target Operating Model
• Partner with Operations Transformation, the Claims Product Owner, IT, and cross-functional teams to co-design solutions and system capabilities
• Represent Claims in system development and testing to ensure functionality, data accuracy, and operational usability
• Drive change management, team readiness, and adoption of new processes and technologies
• Define and monitor key metrics and drive continuous improvement initiatives

Claims Risk Management

• Work with the Claims Risk Manager and Chief Medical Officer to implement a customer-centric, business-value-driven Claims Assessment Philosophy aligned with the company’s risk appetite, while safeguarding reputation and profitability
• Work with the Claims Risk Manager and Chief Medical Officer to ensure the company’s claims practices remain market competitive
• Ensure consistency and integrity in claims assessment approaches and decisions across the team
• Ensure compliance with corporate and regulatory guidelines
• Ensure claims audits are completed in accordance with corporate requirements

Pre-assessment Management

• Oversee the Pre-assessment team to deliver timely, consistent support to distribution channels, customers, and internal stakeholders
• Ensure pre-assessment practices align with claims philosophy, product provisions, underwriting considerations, and corporate guidelines
• Monitor service quality, turnaround time, and case consistency to support effective claims experience delivery

Distribution Channel Management

• Maintain effective two-way relationships with distribution channels to gather market feedback on claims practices, processes, and service support
• Train and guide distribution channels to understand and support the company’s claims philosophy

New Product Development/Claims Initiatives

• Ensure smooth rollout of product and claims initiatives in alignment with corporate policies and guidelines
• Collaborate with relevant stakeholders to develop claims assessment practices for new products and claims initiatives
• Ensure effective and timely training of claims assessors for new or revised guidelines

Team Development

• Build a high-performing team and develop a sustainable succession plan
• Demonstrate leadership capability to develop an engaged, client-centric team that delivers sustainable business, operational, employee, and customer outcomes
• Strengthen talent development, performance management, and team effectiveness to support business continuity and succession objectives

Accountabilities (Individual / Shared):

Individual Accountabilities:

• Claims Performance Management and Operations
• Customer and Claims Experience
• Team Leadership and Talent Development

Key Shared Accountabilities:

• Claims Transformation and Digital Enablement
• New Product Development and Claims Initiatives
• Customer Experience and Complaint Management
• Business Continuity and Operational Resilience

Knowledge/Skills/Competencies/Education:

• Degree in Insurance, Finance, Business Administration or a related field
• At least 15 years of claims experience, including leadership experience in life insurance claims
• Proven experience in claims operations management, performance management, governance, and regulatory compliance
• Experience in process improvement, automation, digital transformation, and claims operating model design
• Transformation-ready leadership skills
• Customer-centric mindset with sound commercial judgment and risk awareness
• Proven leadership capability in talent development, succession planning, coaching, and team engagement
• Effective stakeholder management skills across distribution, product, underwriting, medical, actuarial, legal, compliance, IT, vendors, and external partners
• Change management capability to lead teams through transformation and embed new ways of working
• Effective communication, influencing, problem-solving, and decision-making skills