Specialist - Major Claims (Death & Critical Illness)

At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.

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About the Role

Provides high-quality, timely, and accurate Major Claims services (Death and Critical Illness) within delegated authority, in line with Company policies, service benchmarks and risk standards.

• Review claims documentation, policy coverage, medical evidence, and loss details to determine claim validity, liability, and entitlement in accordance with Company guidelines and delegated authority.

• Assess, review, investigate, approve and process Major Claims (Death and Critical Illness) accurately and timely, applying sound technical judgment and appropriate risk controls.

• Utilize digital claims systems, workflow tools, and data dashboards to manage claim assessments, monitor turnaround time and ensure adherence to service level and quality benchmarks.

• Leverage available automation and AI-enabled tools to enhance assessment efficiency, consistency, and accuracy

• Liaise with Medical Advisors to obtain clinical guidance and clarification where required, ensuring informed and well supported claim decisions.

• Perform effective suspense management, follow up on outstanding requirements, and liaise with Finance and relevant stakeholders to ensure timely and accurate claim payments.

• Actively discuss, document, and escalate complex or disputed claims to senior assessors or management for guidance and resolution, supported by clear analysis and recommendations.

• Contribute to continuous process improvement initiatives by identifying operational inefficiencies, recurring issues, and improvement opportunities within Major Claims workflows.

• Participate in innovation initiatives (e.g. system enhancements, pilot tools, process simplification), providing user feedback and supporting adoption at the operational level.

• Support knowledge sharing and capability building within the team by sharing best practices, lessons learned and updates on process or system changes.

• Perform other tasks and responsibilities as assigned to meet operational requirements and evolving business needs.

Requirements

• Education qualification in Biomedical, Biology, Medicine, Nursing or related fields

• Minimum 2 years Major Claimsexperience (death, critical illness and/or total permanent disability)

• Experience in Life insurance will be an added advantage

• Strong English writing skills.

• Good communication skill.

• Self-motivated and customer-driven

• Sound problem solving skill