Claims Officer (For Pooling)

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Job ID 2026-25832
MAIN PURPOSE
OF THE JOB:
The purpose of a Life Claims Officer is to review, assess, recommend, and/or make decisions on individual life insurance or claims originating through strategic partnerships, employee benefits-related life insurance claims submitted by policyholders, employees, beneficiaries, brokers, HR or other authorized parties ensuring accurate and timely settlement while maintaining collaboration with partner organization or distributors.
KEY ACCOUNTABILITIES:
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Reviewing life claims and verifying the accuracy of submitted information
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Assess claims against policy terms, conditions, and exclusions
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Processing claims for payment, ensuring coverage validity and correct coding
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Examining claims for potential fraud or abuse
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Ensure compliance with internal policies, regulatory standards, and statutory requirements.
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Communicating with employees, beneficiaries, and internal stakeholders to answer queries and resolve issues
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Identify and escalate complex or suspicious claims for further review
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Calculate claim payouts and prepare settlement/decision letter
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Maintain detailed records of claim assessments and communications.
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Contribute to continuous improvement of claims processing procedures.
KEY
STAKEHOLDERS:
Internal: Claims Services, Distribution Services,
External: Network Partners, Clients, Distributors
EXPERIENCE
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Proven experience in processing life insurance of individual and group/partnership claims
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In-depth knowledge of life insurance claims processes and terminology.
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Excellent communication, interpersonal and negotiation skills to liaise with internal and external stakeholders involved in the claims process.
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Strong understanding of data privacy, confidentiality, and fraud detection in individual or partner-sourced claims, compliance standards in the insurance sector, and regulatory requirements
QUALIFICATIONS
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A bachelor's/college degree. Paramedical course is preferred but not required.
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Certification in insurance (e.g., CPCU, LOMA) is a plus.
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At least 3 years experience in processing life claims, partnership management, or medical or forensic investigations related to claims.
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Strong computer literacy, especially with MS Office applications
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Communication Skills:
Excellent verbal and written communication skills with ability to effectively articulate policy terms and conditions, and claims decision.
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Problem Solving Abilities:
Strong analytical and problem-solving skills to identify claim processing gaps and recommend effective solutions for implementation.
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Knowledge of relevant regulations and compliance standards in the insurance sector including data privacy, anti-bribery and corruption laws.
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At AXA, each person matters. We perform at our best knowing the positive impact we make as valuable partners for our customers and the communities we belong to.
If you want to know more about the other career opportunities at AXA Philippines, please follow this link:
https://careers.axa.com/axa-entities/axa-philippines