Director / Associate Director, Claims

About the role

Manulife is seeking a seasoned and strategic Director / Associate Director to support the Team Manager in overseeing end-to-end claims business-as-usual for Group and Individual Life & Health businesses, covering reimbursement and cashless / pre-authorisation processes. The role is accountable for complex escalated cases and complaints, key controls, rising claim volumes and fraud, waste and abuse (FWA) activities, and for delivering an excellent claims experience while managing risk and supporting distribution channels.

Key responsibilities

• Support the team manager in overseeing end-to-end claims operations across reimbursement and cashless processes, ensuring fair, efficient and transparent handling.
• Manage complex cases, complaints and appeals with stakeholders, and monitor performance to drive improvement amid rising workloads.
• Adjudicate and review complex or escalated claims, major and minor, in line with policy and regulatory requirements, and maintain and update manuals and guidelines.
• Handle complex complaints and claim disputes, liaise with regulators on claims matters, and work with the Customer Service Team to improve customer experience and NPS.
• Work with the Claims Risk Manager and Chief Medical Officer to align claims practice with the company's risk appetite, strengthen risk-based assessment for higher-risk and FWA-suspected cases, and train claims assessors on new guidelines.

Required profile

• Degree holder or above.
• At least 10 years of claims experience in Individual and/or Group Life & Health.
• Experience in FWA management, complaints handling and regulatory interaction strongly preferred.
• Professional qualifications such as FLMI preferred.
• Able to work independently under tight schedules and lead remote teams.

Required skills

• Proficiency in MS Word, MS Excel, MS PowerPoint and Chinese word processing.
• Good command of English, Chinese and Mandarin, spoken and written.
• Knowledge of insurance products and regulations such as AML, FATCA, CRS and local insurance regulations.