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.

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer

At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact [email protected].

Working Arrangement