Director / Associate Director, Claims

Overview

We are seeking a seasoned and strategic Director / Associate Director to support the Team Manager in overseeing the end‑to‑end Claims BAU for both Group and Individual Life & Health businesses, covering reimbursement and cashless / pre‑authorization (PA) processes.

This role is accountable for complex, escalated case and complaint handling, ownership of key controls, and effective management of rising claim volumes and FWA (Fraud, Waste & Abuse) activities. The focus is on delivering exceptional claims experience, managing risk, supporting distribution channels, and fostering team development. This role also involves collaborating with various stakeholders to drive operational and service excellence in claims initiatives.

Key Responsibilities

Claims Operations

Support the team manager in overseeing the end-to-end claims operations across reimbursement and cashless processes, ensuring fair, efficient and transparent claims handling.

Collaborate with stakeholders to manage complex cases, complaints, and appeals, ensuring smooth professional resolution.

Monitor operational performance and drive improvement initiatives to sustain service excellence amid rising workloads.

Continuously enhance business processes, workflows and capacity to support business growth.

Adjudicate and review complex or escalated claims, both major and minor, in accordance with policy provisions and regulatory requirements.

Maintain and regularly update manuals and guidelines to reflect current best practices for both reimbursement and cashless claims.

Regulatory Matters & Customer Experience

Lead the handling of complex complaints and claim disputes, ensuring fair outcomes and clear communication.

Liaise with regulatory bodies on claims‑related matters, ensuring timely, accurate responses and alignment with regulatory requirements.

Collaborate closely with the Customer Service Team to study customer pain points across reimbursement and cashless/PA claims journeys, and co‑develop improvement actions.

Regularly review claims communications and operational practices to enhance overall customer experience and NPS outcome.

Claims Risk Management

Collaborate with the Claims Risk Manager and Chief Medical Officer to ensure the claims practices are consistent, prudent, customer-centric, and aligned with the company's risk appetite and market standards.

Ensure consistency and integrity in the claims assessment and decision-making across the reimbursement and cashless claims teams.

Strengthen risk‑based assessment frameworks, with a focus on higher‑risk and FWA‑suspected cases.

Ensure the timely and competent training of claims assessors on new or revised guidelines, including the nuances of cashless claims processing.

Required Qualifications

Degree holder or above.

At least 10 years of claims experience in Individual and/or Group Life & Health business.

Experience in FWA management, complaints handling and regulatory interactions is strongly preferred.

Professional qualifications (e.g. FLMI) are preferred.

Proficient knowledge of insurance products and regulatory requirements (e.g. AML, FATCA, CRS, local insurance regulations).

Able to work independently under tight schedule and lead remote teams.

Strong attention to detail.

Excellent interpersonal, stakeholder management and communication skills, including complaint resolution and negotiation.

Strong analytical, problem‑solving and conflict resolution capabilities.

Proficiency in MS Word, MS Excel, MS PowerPoint, and Chinese Word Processing.

Good command of English, Chinese, and Mandarin, both spoken and written.

When you join our team:

We’ll empower you to learn and grow the career you want.

We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

As part of our global team, we’ll support you in shaping the future you want to see.

宏利金融有限公司是全球领先的金融服务提供商，致力于帮助大众轻松作出明智抉择，实现精彩人生。如欲了解更多关于我们的信息，请访问人寿保险-养老保险-健康保险-中宏保险官网 (manulife-sinochem.com).

宏利是平等機會僱主

在宏利／恒康，我們擁抱多元。我們致力於吸引、培養及挽留和所服務客戶同樣多元的員工，並從而營造包容的工作環境，接納文化和個體差異。我們矢志維持公平的招聘、挽留、晉升及薪酬制度，我們管理的所有實踐及項目不會因種族、血統、原籍地、膚色、族裔、國籍、宗教或宗教信仰、信仰、性別（包括懷孕及其相關情況）、性取向、遺傳特徵、退伍軍人身份、性別認同、性別表達、年齡、婚姻狀況、家庭狀況、殘疾或受適用法律保護的任何其他因素而區別對待。

我們的首要任務是消除障礙，為員工提供平等就業機會。人力資源部代表將盡力為應徵過程中提出要求的申請人提供合理協助。申請人要求提供協助所分享的信息將會按照適用法律及宏利／恒康政策儲存及使用。應徵過程中如需協助，請聯絡 hr@manulife.com。

Working Arrangement

混合办公