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Claims Officer (Medical)


Job Summary

  • Maintain the smooth daily operation of claims section
  • Monitor the claims operational flow in terms of claims turnaround time, hotline service and quality of outgoing claims correspondence
  • Claims assessment in compliance with authority levels
  • Support the claims function in prompt and accurate settlement of claims and negotiation with different parties
  • Ensure claims procedure in compliance with company’s rules and successful implementation of procedures to avoid claims abuse


Job Accountabilities

  • Meet the claim service standard and turnaround time
  • Involve in approving claims cases within own claims authority; make recommendation to senior for those claims exceeding own authority limits.
  • Responsible for handling enquiries and complaints from customers, sales force, other insurance regulatory bodies and internal staff
  • Provide administration support in claims area such as compose claims correspondences, set up, review and revise claims procedure or guidelines or workflows and claims forms, etc.
  • Analyze, provide advice and handling strategy for complaint/appeal claim cases independently
  • Assist in preparing management reports, statistical and analytical claims report in a timely manner for regular claims statistics and irregular claims trends and give proactive suggestions to enhance the quality of works
  • Involve in departmental / company projects where necessary
  • Assist in any ad-hoc projects, system enhancement or tasks assigned by the superior
  • Back-up teammate’s work if necessary due to insufficient manpower of the team


Job Qualifications

  • Degree / Diploma holder or High School graduate with relevant claims work experience
  • Professional qualification in Life Insurance including FLMI (Fellow, Life Management Institute) is preferable
  • Over 2 years experience in Medical Insurance claims handling
  • Knowledge of Medical insurance products, claims procedure and operations
  • Experience in handling claims related projects is highly preferred
  • Basic medical skill is preferable
  • Strong customer-oriented mindset & skills
  • Good communication and interpersonal skills
  • Complaint handling skills and with ability to deal with difficult people and mature to handle awful situation
  • Proficient in MS Word, Excel and Chinese word processing
  • Good command of both spoken and written English and Chinese
  • Candidates with different levels of relevant experience will be considered for different positions



Why Zurich


At Zurich, we like to think outside the box and challenge the status quo. We take an optimistic approach by focusing on the positives and constantly asking What can go right? 

We are an equal opportunity employer who knows that each employee is unique - that’s what makes our team so great! 
Join us as we constantly explore new ways to protect our customers and the planet.

  • Location(s):  HK - Hong Kong

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