Associate Manager, Claims

The Associate Manager, Claims will oversee daily claims operations to ensure accurate, timely and consistent processing of medical and employee benefits claims. The role involves supervising the claims team, managing complex cases and escalations, monitoring service standards, and strengthening operational controls.

Working closely with Client Services, Provider Relations, Finance and Technology teams, you will drive improvements in claims administration and support a positive experience for corporate clients, insurers, healthcare providers and members.

Key Responsibilities

Claims Operations

• Oversee the daily assessment, processing and administration of medical and employee benefits claims in accordance with benefit schedules, policy terms, client agreements and established procedures.

• Plan workloads and allocate resources to meet agreed turnaround times, service standards and quality targets.

• Monitor outstanding claims, ageing cases and processing backlogs, and implement timely follow-up actions.

• Review complex, disputed or exceptional claims and approve decisions within delegated authority, escalating cases where required.

• Ensure claims decisions, supporting documents and communications are accurately recorded and maintained.

Team Supervision and Development

• Supervise, coach and guide the claims team on claims assessment, benefit interpretation, system usage and service delivery.

• Conduct regular case reviews and provide feedback to improve accuracy, productivity and consistency.

• Identify training needs and support onboarding, cross-training and staff development.

• Support performance reviews, manpower planning and team coverage to maintain operational continuity.

Stakeholder Management and Service Delivery

• Act as an escalation point for claims-related enquiries, complaints and service issues.

• Work with Client Services and relevant stakeholders to clarify benefit entitlements, resolve discrepancies and communicate claims outcomes clearly.

• Coordinate with healthcare providers and Provider Relations to resolve billing discrepancies and obtain outstanding documentation.

• Liaise with Finance on approved payment files, reconciliation discrepancies and payment-related enquiries.

• Support client and insurer meetings by providing updates on claims performance, recurring issues and improvement actions.

Quality Assurance and Operational Controls

• Conduct quality checks and identify processing errors, duplicate claims, unusual billing patterns and potential misuse.

• Escalate suspected irregularities through established channels and support investigations where required.

• Maintain standard operating procedures, assessment guidelines and appropriate approval controls.

• Support audits, claims reviews and corrective actions, ensuring complete and traceable records.

• Safeguard confidential medical and personal information in accordance with company policies and applicable data protection requirements.

Reporting and Process Improvement

• Prepare and analyse reports on claims volumes, turnaround times, accuracy, productivity, backlogs and service issues.

• Identify root causes of recurring errors and recommend practical improvements.

• Collaborate with Technology and Operations teams on system enhancements, automation and user acceptance testing.

• Support the implementation of new client benefit arrangements and updates to existing schemes.

• Undertake other relevant duties and projects assigned by management.

Requirements

• Diploma or degree in Business Administration, Insurance, Healthcare Management or a related discipline.

• At least 4–6 years of relevant experience in medical claims, health insurance, employee benefits administration or TPA operations, including experience supervising staff or leading a team.

• Sound understanding of medical claims assessment, benefit schedules, policy exclusions and claims administration workflows.

• Strong analytical and problem-solving skills, with good judgement when handling complex cases.

• Strong organisational skills and the ability to manage competing priorities and high transaction volumes.

• Effective communication and stakeholder management skills.

• Proficiency in Microsoft Excel and experience using claims administration systems.

• Experience in quality assurance, operational reporting, process improvement or system implementation would be an advantage.

• A meticulous, service-oriented and collaborative approach, with a strong commitment to confidentiality and accountability.