Job Description
Job Purpose: The successful Life Claims Senior Officer is responsible for a deeper investigation of insurance claims to ensure accuracy and prevent fraud, adjudicate claim terms and conditions in compliance with AXA Philippines guidelines, communicate with claimants and/or distributors, and prepare claims settlements.
Essential Functions: As AXA Philippines Life Claims Senior Officer, you will report to the Life Claims Senior Manager and will utilize your time in:
Claim Case Adjudication
. Adjudicates and approves claim that fall outside Level 1's authority limits, cases that require special handling, or claims submitted for and/or by VIP customers as defined in the Life Claims Business Guidelines
. Supports in the management of workload when other Claims Officers are out, including claim handling and servicing requests
. Adjudicates and approves Death, Critical Illness, Daily Hospitalization Income, Accident Medical Expense reimbursement, Waiver of Premium, Accidental Death & Disability, Permanent Total Disability, and Terminal Illness Benefit claims from the retail (individual) and/or group lines of business within your delegated authority limits and stipulated turnaround time
. Conducts the end-to-end claim case management from claims adjudication to the timely emailing of the decision letter to the claimant and/or distributor using WFI, RLS, iBPS, SCRM, MAP, and MS Outlook as work tools
. Assist Claim Officers, as needed, in conveying the relevant claim terms and conditions with properly identified claimants and/or distributors, via email or a virtual meeting, when encountering objections to the process of obtaining supporting documents
. Reviews and analyzes insurance policies, product technical notes, medical records, and other documentation to determine whether the claim is approved, denied, or needs additional documents.
. Complies with set policies and procedures in the identification of and prevention of losses due to fraudulent claims
. Ensures complete and accurate claim documentation by asking for and obtaining relevant information that will help arrive at the appropriate claim decision. Ensures that all relevant case notes, documents, and correspondences are available in the WFI case file and RLS claim assessment module
. Prepares the complete case summary for claim referral to Level 3, or higher, for cases where the total payable benefit exceeds your delegated authority limits. Makes recommendation on the provisional claim decision on such cases
. Assesses the precise payable amount for the claim benefit (work) type after determining the applicable deductions or additions, if any, using the computing tools provided by AXA Philippines
Customer Service Management
. Provides complete, accurate, and timely responses to all properly identified distributors, Policy Owners, and/or Beneficiaries correspondence via written, chat, and/or e-mail channels regarding claim status, clarification on the required document, or settlement options
. Offers resolution, in coordination with the Claims Coordinator, when necessary, in managing the expectation of the distributor, Policy Owner, and/or Beneficiaries with the goal of maintaining a differentiated customer experience
. Follows up every 2 weeks, or as agreed with the claimant, on the submission of the identified compliance (requirement) documents needed for the complete adjudication of the claim
. Adheres to the service standards of claim processing and email handling according to the defined workflow, Service Level Agreement, Turnaround Time, and Accuracy (Quality) measures of the Life Claims unit
. Attends and/or facilitates product, process, and company trainings directed to the compliance with business and Company policies and guidelines to ensure excellent delivery of customer service
. Communicates and coordinates with the Branch Operations Specialist, Corporate Solutions Account Management team, and/or the distribution channel for process alignment, driving business efficiencies, and/or streamlined servicing of a claimant or client
. Communicates and coordinates with the Underwriting Department for retrospective underwriting on cases whenever required and in compliance with the AXA Group Claim Standards
. Communicates and coordinates with the Legal Department for guidance on cases that require special handling to ensure compliance with the applicable laws of the land and the Insurance Code of the Philippines
. Communicates and coordinates with the Finance Department for following up on the payout status when necessary
Claim Reporting
. Escalates to Compliance and obtains clearance, whenever required, as part of the due diligence process of the AML policy, prior to the claim settlement
. Monitors the performance of the Life Claims Key Performance Indicators and Transitory Account management. Alerts the Senior Manager challenges that may pose a risk to the achievement of the department KPIs
. Drives innovative and best practices that aid in the continuous improvement of Life Claims services and performance
Your Profile
Your Areas of Knowledge, Expertise, and Competencies
. You must be a Bachelor's degree holder of any 4-year course, preferably in the medical sciences, and have at least 5 years of experience in life claims processing or life insurance operations.
. You have earned the ALMI designation and are pursuing higher qualifications from the Life Office Management Institute (LOMA).
. You are an excellent and effective communicator in English and Filipino in both written and verbal forms. You communicate in a pleasant and professional manner.
. You are detail-oriented and analytical. You can draw sound judgment and take a decision on the facts being presented in the claim documentation available to you without missing the important details in the documentation.
. You are a self-driven, motivated individual who shares a commitment to delivering exceptional customer service and provide timely resolution on complex cases.
. You are a highly organized individual who can easily keep track of your responsibilities, deadlines, and promises made to a claimant and/or distributor.
. You can work under minimal supervision, can prioritize work, and handle varying work demands.
. You have good computer skills with good command of MS Excel, Word, and Outlook programs.
. You can work professionally and ethically with department colleagues, clients, claimants, vendors, and distributors.
. You possess a growth mindset, believing and pursuing that learning and improvement is a life-long endeavor.
About AXA
A global leader in insurance and investments, AXA takes care of 103 million lives in 64 countries worldwide. We actively invest in pioneering and personalized solutions to meet your ever-changing needs and exceed your expectations. In the Philippines, we are in partnership with Metrobank, one of the country's strongest banks.
About the Entity
Established in 1999, AXA Philippines is one of the largest and fastest growing life insurance companies in the country. It offers financial security to more than one million individuals through its group and individual life insurance as well as general insurance products through its subsidiary Charter Ping An.
AXA Philippines is one of the first to introduce bancassurance operations in the country, and is among the pioneers in the investment-linked insurance sector.
AXA now offers a complete range of products for all its customers insurance and financial protection needs, including savings and investments, health plans, income protection, and health coverage and through its general insurance subsidiary Charter Ping An Insurance Corporation: fire, motor car, marine cargo, personal accident, bonds, casualty, and engineering insurance products.
AXA Philippines closed 2017 with P26.4 billion in total premium income and P5.7 billion in gross written premiums from Charter Ping An. Today, AXA has more than 4,000 financial advisers in 36 branches, and 700 financial executives in over 900 Metrobank and PSBank branches nationwide. Charter Ping An, on the other hand, has 22 branches nationwide and 2,007 agents.
AXA Philippines is a joint venture between the AXA Group, headquartered in France, and the Metrobank Group, one of the largest financial conglomerates in the Philippines.
The Metrobank Group is a conglomerate of industry-leading businesses that includes First Metro Investment Corporation, Metrobank Credit Cards, Federal Land, Toyota, and Manila Doctors Hospital. It was hailed Best Bank in the Philippines in 2010, 2011, and 2012 by Euromoney and recognized as the strongest bank in the Philippines by The Asian Banker in 2013. It is owned by the Ty Family whose major business interests include financial services, real estate development, power, and manufacturing.
What We Offer
Please visit for more information.
Job Purpose: The successful Life Claims Senior Officer is responsible for a deeper investigation of insurance claims to ensure accuracy and prevent fraud, adjudicate claim terms and conditions in compliance with AXA Philippines guidelines, communicate with claimants and/or distributors, and prepare claims settlements.
Essential Functions: As AXA Philippines Life Claims Senior Officer, you will report to the Life Claims Senior Manager and will utilize your time in:
Claim Case Adjudication
. Adjudicates and approves claim that fall outside Level 1's authority limits, cases that require special handling, or claims submitted for and/or by VIP customers as defined in the Life Claims Business Guidelines
. Supports in the management of workload when other Claims Officers are out, including claim handling and servicing requests
. Adjudicates and approves Death, Critical Illness, Daily Hospitalization Income, Accident Medical Expense reimbursement, Waiver of Premium, Accidental Death & Disability, Permanent Total Disability, and Terminal Illness Benefit claims from the retail (individual) and/or group lines of business within your delegated authority limits and stipulated turnaround time
. Conducts the end-to-end claim case management from claims adjudication to the timely emailing of the decision letter to the claimant and/or distributor using WFI, RLS, iBPS, SCRM, MAP, and MS Outlook as work tools
. Assist Claim Officers, as needed, in conveying the relevant claim terms and conditions with properly identified claimants and/or distributors, via email or a virtual meeting, when encountering objections to the process of obtaining supporting documents
. Reviews and analyzes insurance policies, product technical notes, medical records, and other documentation to determine whether the claim is approved, denied, or needs additional documents.
. Complies with set policies and procedures in the identification of and prevention of losses due to fraudulent claims
. Ensures complete and accurate claim documentation by asking for and obtaining relevant information that will help arrive at the appropriate claim decision. Ensures that all relevant case notes, documents, and correspondences are available in the WFI case file and RLS claim assessment module
. Prepares the complete case summary for claim referral to Level 3, or higher, for cases where the total payable benefit exceeds your delegated authority limits. Makes recommendation on the provisional claim decision on such cases
. Assesses the precise payable amount for the claim benefit (work) type after determining the applicable deductions or additions, if any, using the computing tools provided by AXA Philippines
Customer Service Management
. Provides complete, accurate, and timely responses to all properly identified distributors, Policy Owners, and/or Beneficiaries correspondence via written, chat, and/or e-mail channels regarding claim status, clarification on the required document, or settlement options
. Offers resolution, in coordination with the Claims Coordinator, when necessary, in managing the expectation of the distributor, Policy Owner, and/or Beneficiaries with the goal of maintaining a differentiated customer experience
. Follows up every 2 weeks, or as agreed with the claimant, on the submission of the identified compliance (requirement) documents needed for the complete adjudication of the claim
. Adheres to the service standards of claim processing and email handling according to the defined workflow, Service Level Agreement, Turnaround Time, and Accuracy (Quality) measures of the Life Claims unit
. Attends and/or facilitates product, process, and company trainings directed to the compliance with business and Company policies and guidelines to ensure excellent delivery of customer service
. Communicates and coordinates with the Branch Operations Specialist, Corporate Solutions Account Management team, and/or the distribution channel for process alignment, driving business efficiencies, and/or streamlined servicing of a claimant or client
. Communicates and coordinates with the Underwriting Department for retrospective underwriting on cases whenever required and in compliance with the AXA Group Claim Standards
. Communicates and coordinates with the Legal Department for guidance on cases that require special handling to ensure compliance with the applicable laws of the land and the Insurance Code of the Philippines
. Communicates and coordinates with the Finance Department for following up on the payout status when necessary
Claim Reporting
. Escalates to Compliance and obtains clearance, whenever required, as part of the due diligence process of the AML policy, prior to the claim settlement
. Monitors the performance of the Life Claims Key Performance Indicators and Transitory Account management. Alerts the Senior Manager challenges that may pose a risk to the achievement of the department KPIs
. Drives innovative and best practices that aid in the continuous improvement of Life Claims services and performance
Your Profile
Your Areas of Knowledge, Expertise, and Competencies
. You must be a Bachelor's degree holder of any 4-year course, preferably in the medical sciences, and have at least 5 years of experience in life claims processing or life insurance operations.
. You have earned the ALMI designation and are pursuing higher qualifications from the Life Office Management Institute (LOMA).
. You are an excellent and effective communicator in English and Filipino in both written and verbal forms. You communicate in a pleasant and professional manner.
. You are detail-oriented and analytical. You can draw sound judgment and take a decision on the facts being presented in the claim documentation available to you without missing the important details in the documentation.
. You are a self-driven, motivated individual who shares a commitment to delivering exceptional customer service and provide timely resolution on complex cases.
. You are a highly organized individual who can easily keep track of your responsibilities, deadlines, and promises made to a claimant and/or distributor.
. You can work under minimal supervision, can prioritize work, and handle varying work demands.
. You have good computer skills with good command of MS Excel, Word, and Outlook programs.
. You can work professionally and ethically with department colleagues, clients, claimants, vendors, and distributors.
. You possess a growth mindset, believing and pursuing that learning and improvement is a life-long endeavor.
About AXA
A global leader in insurance and investments, AXA takes care of 103 million lives in 64 countries worldwide. We actively invest in pioneering and personalized solutions to meet your ever-changing needs and exceed your expectations. In the Philippines, we are in partnership with Metrobank, one of the country's strongest banks.
About the Entity
Established in 1999, AXA Philippines is one of the largest and fastest growing life insurance companies in the country. It offers financial security to more than one million individuals through its group and individual life insurance as well as general insurance products through its subsidiary Charter Ping An.
AXA Philippines is one of the first to introduce bancassurance operations in the country, and is among the pioneers in the investment-linked insurance sector.
AXA now offers a complete range of products for all its customers insurance and financial protection needs, including savings and investments, health plans, income protection, and health coverage and through its general insurance subsidiary Charter Ping An Insurance Corporation: fire, motor car, marine cargo, personal accident, bonds, casualty, and engineering insurance products.
AXA Philippines closed 2017 with P26.4 billion in total premium income and P5.7 billion in gross written premiums from Charter Ping An. Today, AXA has more than 4,000 financial advisers in 36 branches, and 700 financial executives in over 900 Metrobank and PSBank branches nationwide. Charter Ping An, on the other hand, has 22 branches nationwide and 2,007 agents.
AXA Philippines is a joint venture between the AXA Group, headquartered in France, and the Metrobank Group, one of the largest financial conglomerates in the Philippines.
The Metrobank Group is a conglomerate of industry-leading businesses that includes First Metro Investment Corporation, Metrobank Credit Cards, Federal Land, Toyota, and Manila Doctors Hospital. It was hailed Best Bank in the Philippines in 2010, 2011, and 2012 by Euromoney and recognized as the strongest bank in the Philippines by The Asian Banker in 2013. It is owned by the Ty Family whose major business interests include financial services, real estate development, power, and manufacturing.
What We Offer
Please visit for more information.
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AXA MANDIRI FINANCIAL SERVICES
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AXA MANDIRI FINANCIAL SERVICES jobs
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