Claims Manager

CLAIMS MANAGER

A leading organisation in Makati is seeking a Claims Manager to spearhead the transformation of its claims function. This pivotal role offers you the opportunity to establish and operationalise a new model office that integrates adjudication, automation, validation, audit, and fraud investigation capabilities. As a key figure in the Claims Transformation Programme, you will shape the future of claims operations by building scalable processes and fostering a culture of continuous improvement. The position provides an exciting platform for you to demonstrate your expertise in business process transformation and fraud management while working closely with executive stakeholders. With a focus on quality standards, regulatory compliance, and operational excellence, this role promises both challenge and reward for those passionate about making a tangible impact within a supportive environment.

* Play a central role in designing and launching a next-generation operating model for claims management, integrating advanced automation and robust governance frameworks to ensure efficiency and compliance.
* Lead the development of high-performing teams by defining roles, structures, and competency frameworks while nurturing a culture of accountability, collaboration, and ongoing professional growth.
* Drive operational excellence through strategic oversight of performance metrics, service level agreements, and continuous process optimisation—ensuring alignment with organisational objectives and industry best practices.

What you'll do:

As Claims Manager, you will be at the forefront of transforming how claims are managed within the organisation. Your day-to-day responsibilities will involve establishing a new operational unit that brings together multiple disciplines under one cohesive framework. You will be instrumental in setting up governance structures that underpin every aspect of claims processing—from initial adjudication through to final audit—while ensuring all activities align with regulatory expectations. By developing SOPs and performance metrics tailored to automated environments, you will enable your team to deliver consistently high-quality outcomes. Your leadership will extend beyond process design; you will also play a vital role in recruiting top talent, nurturing their growth through targeted training programmes, and instilling a culture rooted in accountability. Through your efforts in implementing advanced analytics tools and reporting systems, you will provide actionable insights that drive continuous improvement across all facets of claims operations. Ultimately, your work will lay the foundation for a resilient model office capable of adapting to evolving business needs while maintaining unwavering commitment to integrity.

* Design and implement an innovative operating model for the Claims Function that seamlessly integrates adjudication, automation, validation, auditing, and investigative functions to deliver superior outcomes.
* Define comprehensive governance frameworks and performance systems that support end-to-end claims processes while ensuring adherence to quality standards and regulatory requirements.
* Develop detailed Standard Operating Procedures (SOPs), set ambitious service level targets, and establish clear escalation mechanisms to guarantee consistent operational delivery.
* Shape the organisational structure by defining roles for adjudicators, auditors, and specialised units dedicated to special handling and investigations within the Model Office.
* Lead recruitment initiatives, oversee onboarding processes, and drive capability-building programmes to empower your team with the skills needed for success.
* Foster an environment of accountability by promoting continuous improvement practices and operational discipline across all levels of the workforce.
* Establish key performance indicators (KPIs), service level agreements (SLAs), and quality benchmarks tailored to automation-driven operations for optimal results.
* Oversee calibration of auto-adjudication logic as well as exception handling protocols to ensure system configurations are optimised for accuracy and efficiency.
* Implement robust reporting mechanisms and analytics tools to monitor performance trends, identify emerging issues promptly, and initiate corrective actions where necessary.
* Champion governance, audit controls, and Fraud, Waste, and Abuse (FWA) detection practices by embedding monitoring systems that proactively address operational risks.

What you bring:

To excel as Claims Manager in this transformative environment, you will bring not only technical expertise but also exceptional interpersonal qualities. Your background should include significant experience overseeing claims operations—ideally within shared services or BPO settings—where you have demonstrated your ability to manage complex workflows efficiently. A deep understanding of FWA management is critical; your insight into risk identification and mitigation will help safeguard organisational integrity. Your academic credentials should reflect relevant fields such as Business Administration or Healthcare Management. Beyond technical know-how, your success hinges on your ability to engage diverse stakeholders effectively—building consensus among transformation teams while communicating clearly with executive leaders. Your strategic mindset enables you to see both immediate priorities and long-term objectives; meanwhile your analytical prowess ensures data-driven decision-making at every turn. Experience leading cultural change is highly valued here: you must be adept at inspiring teams towards shared goals while embedding best practices that foster ongoing improvement. Above all else, your dependability makes you a trusted partner who can be relied upon during periods of significant organisational change.

* Bachelor’s degree in Business Administration, Healthcare Management or related field is required as it provides essential foundational knowledge for this complex role.
* At least five years’ experience in Claims Operations with proven track record in leadership positions within shared services or outsourced environments is essential for effective team management.
* Demonstrated ability to design and operationalise new operating models or lead large-scale transformation programmes is crucial for driving change successfully.
* Comprehensive understanding of Fraud, Waste, and Abuse (FWA) management along with hands-on experience in claims adjudication processes ensures robust risk mitigation strategies.
* Expertise in developing governance frameworks as well as managing performance metrics enables you to maintain high standards across all operations.
* Exceptional interpersonal skills including stakeholder engagement abilities are vital for fostering collaboration between transformation teams and executive partners.
* Strategic thinking combined with strong analytical skills allows you to translate vision into actionable plans that deliver measurable results.
* Experience managing hybrid or outsourced delivery environments equips you with flexibility needed for today’s dynamic business landscape.
* Proven capability in leading cultural transformation initiatives helps embed continuous improvement mindsets throughout the organisation.
* Strong business acumen paired with results-oriented approach ensures alignment between operational activities and broader organisational goals.

What sets this company apart:

This organisation stands out as an industry leader committed to redefining excellence within claims management through investment in people-centric transformation initiatives. Employees benefit from being part of an inclusive workplace where collaboration is encouraged at every level—enabling individuals like yourself to share ideas freely while learning from knowledgeable colleagues across disciplines. The company places strong emphasis on professional development by offering access to training opportunities designed around current industry trends; this ensures staff remain ahead of regulatory changes while continuously enhancing their skill sets. Flexible working arrangements further support work-life balance so employees can thrive both personally and professionally. With supportive leadership focused on empowering teams rather than imposing rigid hierarchies—and a genuine commitment towards ethical conduct—the organisation provides an environment where everyone feels valued for their unique contributions. If you are looking for more than just another job but rather a place where your expertise can make lasting impact alongside like-minded professionals dedicated to positive change then this is the ideal destination for your next career move.

What's next:

If you are ready to take on this rewarding challenge as Claims Manager and contribute meaningfully towards shaping the future of claims operations we encourage you to apply now!

Apply today by clicking on the link provided—your next career milestone awaits!

Due to the high volume of applications we are experiencing, our team will only be in touch with you if your application is shortlisted.