Head of Retail Claims

SUMMARY:

The Head of Retail Claims will lead the end-to-end retail claims function, ensuring operational excellence, regulatory compliance (in line with NFRA’s requirements), and superior customer service. This role will drive the integration of risk management, claims marketing, and customer-centric innovation across all retail insurance products. This role requires deep expertise in China’s insurance landscape, regulatory frameworks, and digital innovation.

KEY TASKS & ACCOUNTABILITIES

1. Leadership & Strategy

• Lead, develop, and mentor the retail claims team, fostering a high-performance and collaborative culture.
• Set and execute claims strategy aligned with business objectives and evolving regulatory requirements in China.

2. Claims Operations Management

• Oversee all retail claims processes, ensuring timely, accurate, and fair claims resolution.
• Integrate risk management principles and claims marketing into daily operations and emergency assistance services.
• Maintain robust service systems and implement process improvements for efficiency and customer satisfaction.

3. Regulatory and Compliance Management

• Ensure strict adherence NFRA’s requirements, internal policies and service standard.
• Identify, assess, and mitigate operational, compliance, and fraud risks throughout the claims lifecycle.

4. Key Account & Vendor Management

• Manage relationships with major clients, partners, and service providers, ensuring service standards and contract compliance.
• Oversee third-party vendor performance, contract negotiation, and quality assurance.

5. Product & System Development

• Collaborate with underwriting and product teams on claims-related aspects of new product development and enhancements.
• Contribute claims expertise to system development and digital transformation initiatives.

6. Training

• Deliver training and presentations to internal teams and external partners on claims handling, fraud prevention, and regulatory changes. 

QUALIFICATIONS/EXPERIENCE

• Bachelor’s degree with major in Law, Medical or Insurance will be plus
• 15+ years’ experience in Claims operations, risk management, and major account management
• 10+ years of proven team management and leadership experience
• Expertise in medical claims, travel and AH products, vendor management and fraud investigation
• Experience in claims workflow design and service system development
• Deep understanding of regulatory frameworks and NFRA’s requirements in China
• Strong analytical, communication, and presentation skills
• Excellent stakeholder management and customer service orientation
• Professional medical or insurance qualifications preferred; proficiency in English and Mandarin (both oral & written)

Key Competencies

• Goal Orientated with Strong Execution
• Change Leadership & Innovation
•  Regulatory & Risk Awareness
• Customer Focus Mindset
• Data Driven Decision Making
• Team Empowerment & Development

Business Accountabilities

• Set, agree and control budgets for China Retail Claims (CRC) and propose investments in order to ensure objectives are achieved in line with the organization's goals
• Lead the CRC, program implementation in complex cross functional/organizational environments, which change the way claims operates aligned to the organization's strategy.
• Lead in the development of policy/governance/regulatory standards within CRC in order to define the organization's policy position and ensure compliance with regulators
• Review, interpret and shape CRC policy and processes taking into account local, regulatory and legal frameworks, providing authoritative advice to colleagues to ensure their effective implementation
• Lead the development of processes and standards aligned to global policy and brand values, yet suitable for local markets to deliver espoused levels of customer service
• Contribute to the development of business strategy in claims and provide CRC guidance and support to the wider leadership team