Claims, Consultant
AIA Group · Hong Kong, Macau
At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.
It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.
And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.
Sound like you? Then read on.
About the Role
This role contributes to the delivery of customer outcomes that are reliable, thoughtful, and create meaningful impact for customers and society. The role holder is expected to embed a customer first mindset in all decisions and actions by developing a clear understanding of customer needs, taking end to end ownership to resolve issues, and working collaboratively across teams to continuously enhance the customer journey—both directly and indirectly.Responsible for delivering high-quality, end-to-end management of High Net Worth (HNW) claims, ensuring accurate adjudication, exceptional service to distribution channels, and strong compliance with regulatory and governance requirements. The role also supports fraud risk mitigation, contributes to product development, and participates in business and transformation initiatives.
In addition, the role manages and resolves customer complaints related to claims by providing fair, timely, and well-reasoned assessments, ensuring alignment with regulatory requirements and maintaining a strong focus on customer trust and experience.
Responsibilities:
High Net Worth Claims Management
- Manage the end-to-end processing of HNW claims, ensuring accurate, consistent, and timely adjudication in line with policy terms and internal guidelines
- Maintain strong quality control and cost management, optimizing claim outcomes while upholding customer-centric service standards
- Provide proactive, clear, and empathetic communication to distribution channels throughout the claims lifecycle to enhance customer experience
- Collaborate closely with the Transaction Hub, Underwriting, and other internal stakeholders to ensure seamless claims handling and service delivery
Complaint Handling & Customer Resolution
- Manage and resolve customer complaints related to claims, ensuring fair, balanced, and well-reasoned outcomes aligned with policy terms and regulatory requirements
- Handle complex and escalated cases, including those with potential reputational, regulatory, or channel impact (e.g. media, IA, or ICB-related cases)
- Provide clear and empathetic communication to customers and stakeholders, maintaining trust and transparency throughout the resolution process
- Conduct root cause analysis on complaint cases, identifying systemic issues and recommending process or guideline enhancements to prevent recurrence
- Collaborate with internal stakeholders (e.g. Legal, Compliance, Channels) to ensure consistent and defensible complaint handling
Compliance & Governance
- Act as Claims Subject Matter Expert (SME) for regulatory and compliance initiatives, including FATCA, CRS, and AML, ensuring adherence to internal policies and external requirements
- Coordinate and manage alerts from IFPCD, taking timely and effective actions to detect, investigate, and mitigate potential fraudulent claims
- Review and enhance internal claims guidelines, and deliver training to stakeholders to drive consistency, awareness, and compliance across teams
Product Development & Design Support
- Provide claims insights and technical input during product design and enhancement to ensure clarity, consistency, and operational feasibility of policy terms and benefit structures
- Partner with Product, Underwriting, and Distribution teams to review product features, exclusions, and claims triggers, minimizing ambiguity and improving claims adjudication effectiveness
- Identify potential claims risk exposure, anti-selection, and cost implications, and recommend mitigation measures during product development
- Support post-launch reviews by sharing claims experience, emerging trends, and feedback to refine product design and improve customer outcomes
Business Support & Projects
- Support the Team Head in executing business priorities, operational initiatives, and ad hoc assignments
- Coordinate with auditors, reinsurers, and cross-functional teams to ensure timely and accurate responses to governance and reporting requirements
- Participate in projects and transformation initiatives, contributing to process improvements, operational efficiency, and alignment with evolving business needs
Requirements:
- Bachelor’s degree or above in Insurance, Business Administration, Healthcare, or a related discipline
- Minimum 6–8 years of relevant claims experience, with solid exposure to High Net Worth (HNW) or complex claims handling
- Strong technical claims expertise, with proven ability to manage complex cases, complaint handling, and deliver fair and well-reasoned adjudication outcomes
- Good understanding of regulatory and compliance requirements (e.g. AML, FATCA, CRS) and experience in governance-related activities
- Experience in handling escalations and complaint cases, with the ability to assess reputational and regulatory risks and manage stakeholder communications effectively
- Exposure to fraud detection and investigation processes is an advantage
- Experience in supporting product development or reviewing policy terms, with the ability to identify claims implications and operational considerations
- Professional qualifications such as FLMI, ALHC or equivalent are preferred
- Strong analytical, problem-solving, and decision-making skills, with attention to detail and sound judgment
- Excellent communication and stakeholder management skills, with the ability to engage effectively with Channels, internal teams, and external parties
- Demonstrated ownership, accountability, and ability to work independently, with the capability to contribute to a team and project environment
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.
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