Ref. no.: FM.04.022026

職位內容 Responsibilities

• 處理人壽和非人壽業務的理賠
• 負責實施、維護和監控所有理賠結算流程，確保符合公司標準和程序
• 監控和控制所有理賠結算，確保為未決理賠支付預留充足資金，以維持公司償付能力
• 評估理賠情況，並向管理階層提出支付建議
• 監控理賠趨勢，並向高階管理層和其他部門提供必要的統計資料和報告
• 向保險管理機關提交統計報告，例如員工賠償保險、汽車保險和醫療事故保險等的索賠資料
• 指導外部專業人員（如理賠員、勘察員和律師）處理保險範圍、調查和最終理賠事宜，包括直接參與理賠結算中的法庭/調解和仲裁
• 採取一切可能的追償途徑，包括及時向被保險人追回免賠額，並管理代位求償活動
• 定期檢討準備金設定政策，確保其充足
• 發起和/或參加禮節性拜訪，與重要業務夥伴會面
• 制定並向所有理賠人員實施理賠指南/理賠手冊
• 定期檢視理賠管理政策和程序，確保其充分性和效率，並定期更新理賠手冊
• 為理賠人員提供培訓
• 開發/改進理賠系統，以確保公司在處理理賠的有效性和效率
• 定期監控理賠服務標準

• Claims Handling in both life and non-life business
• To implement, maintain and monitor all claims settlement of portfolio to ensure compliance with company standards and procedures
• To monitor and control all claims settlement to ensure adequate provision is made for outstanding claims payment for solvency
• To evaluate, and make recommendations on Claims Settlement if claims to management
• To monitor trends in claims and provide necessary statistical information and reports for senior management and other departments
• Preparation of statistical report to the insurance authority, i.e. claims data of Employees Compensation Insurance, Motor Insurance and Medical Malpractice Insurance, etc.
• To provide instruction to external professionals like adjusters, surveyors and lawyers with respect to coverage, investigation and ultimate settlement including direct participation in court/mediation and arbitration in claim settlement
• To pursue all avenues of recovery including timely recovery of deductibles from insured and to manage subrogation activities
• To review policy on setting reserves on a regular basis to ensure adequacy
• Initiating and /or attending courtesy visits to meet with important business partners,
• To develop and implement claims guidelines/claims manual to all claims staff
• To review policy and procedure regarding claims management on a regular basis to ensure adequacy and efficiency and to update claims manual on a regular basis
• To provide training for claims staff
• To develop /revamp claims system to ensure company’s effectiveness and efficiency in handling claims
• To monitor claims services standard from time to time

• 大學畢業或以上學歷
• 10 年以上理賠管理經驗
• 良好英文及中文的溝通及書寫能力
• 良好電腦操作技能及文書處理能力，尤其Word 及Excel
• 優秀的溝通及人際交往能力
• 良好的分析及理解能力
• 以客戶為先、積極主動
• 細心、主動、獨立，並能在壓力下工作
• 熟悉保險產品和相關法律知識

• University graduate or above
• 10 years’ experience in claims management
• Good command of spoken and written English and Chinese
• Good knowledge of PC applications, especially Word and Excel
• Effective communication and interpersonal skills
• Good analytical and comprehension skills
• Customer-oriented, pleasant personality
• Detail-oriented, proactive, independent, and able to work under pressure
• Familiar with insurance products and legal knowledge

• Updated and detailed resume (CV)
• Recent photo;
• Any documentation (academic qualification certificates; prior employment letters; etc.) you find relevant;