Head of Claims

FIND YOUR 'BETTER' AT Blue Cross

We don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us.

We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.

If you believe in better, we’d love to hear from you.

About the Role

This role contributes to the delivery of customer outcomes that are reliable, thoughtful, and create meaningful impact for customers and society. The role holder is expected to embed a customer first mindset in all decisions and actions by developing a clear understanding of customer needs, taking end to end ownership to resolve issues, and working collaboratively across teams to continuously enhance the customer journey—both directly and indirectly.
Support Director of Operations and Healthcare Provision in executing the end-to-end claims strategy and overseeing daily claims operations across medical and non-medical insurance portfolios.
This role is accountable for delivering operational excellence, claims efficiency, and customer-centric service, while ensuring compliance with internal governance standards and regulatory requirements. The position plays a key role in driving claims cost containment, enhancing service quality, and supporting the Company’s transformation agenda through digitalisation, automation, and process optimisation.
The role also contributes to the development of a connected claims ecosystem, leveraging strategic partnerships, digital capabilities, and value-based care models to enhance customer outcomes and operational sustainability.
The Head of Claims is responsible for translating strategic priorities into operational execution, managing claims teams, and ensuring achievement of claims-related KPIs, including turnaround time, loss ratio improvement, and customer satisfaction.

Roles and Responsibilities:

Claims Operations Management

• Oversee day-to-day claims operations across medical (In-patient and Out-patient, pre-authorisation, case management) and general insurance lines (motor, property, liability, and others)
• Ensure timely, accurate, and consistent claims adjudication in accordance with policy terms and conditions
• Monitor and manage service levels, turnaround time, and operational efficiency
• Drive continuous improvement and standardisation of claims processes

Claims Cost Management & Performance

• Support delivery of claims-related financial targets, including loss ratio improvement and claims cost containment
• Analyse claims experience, identify trends, and implement measures to address cost drivers and leakage
• Collaborate with Actuarial and Finance on claims reserving, reporting, and performance monitoring
• Strengthen controls to mitigate fraud, waste, and abuse (FWA) risks

Provider & Vendor Management

• Manage operational relationships with medical providers, loss adjusters, lawyers, surveyors, and other service vendors
• Monitor vendor performance and ensure adherence to service standards, contractual terms, and cost benchmarks
• Support development and optimisation of provider and vendor panels to enhance service quality and cost efficiency
  

Customer Experience & Service Excellence

• Drive initiatives to enhance customer experience across the claims journey
• Improve claims communication, transparency, and responsiveness to policyholders and intermediaries
• Handle escalated, complex, and sensitive claims cases in a fair and consistent manner
• Ensure customer-centric decision-making aligned with company values and regulatory expectations

Digital Transformation & Process Optimisation

• Lead implementation of claims digitalisation initiatives, including eClaims, workflow automation, and straight-through processing (STP)
• Support adoption of data analytics and AI tools for claims triage, fraud detection, and process efficiency
• Drive process re-engineering to improve productivity and reduce manual intervention
  

Governance, Risk & Compliance

• Ensure compliance with internal policies, claims authority limits, and regulatory requirements (Insurance Authority and other relevant bodies)
• Maintain robust internal controls and audit readiness across claims operations
• Support governance of large loss, litigation, and complex claims cases
• Ensure proper documentation and adherence to claims governance framework

Stakeholder Management

• Collaborate closely with internal stakeholders, including Underwriting, Product, Distribution, Finance, and Risk functions
• Support Director of Operations and Healthcare Provision in engagement with external stakeholders, including regulators, reinsurers, and service providers
• Contribute to cross-functional initiatives and Group-level alignment where applicable

Ecosystem Development & Strategic Partnerships

• Support the development and execution of the claims ecosystem strategy

• Collaborate with internal stakeholders (Product, Underwriting, Distribution, Healthcare Provision) and external partners to strengthen an integrated ecosystem that enhances customer value and claims outcomes.

• Build and manage strategic partnerships with healthcare providers, repair networks, service vendors, and digital solution partners to deliver value-added services, improve service accessibility, and optimize claims cost efficiency.

• Support initiatives that promote value-based care, preventive care, and customer engagement, including provider steerage, network optimisation, and digital care pathways.

• Contribute to cross-border and regional ecosystem initiatives (e.g. GBA healthcare integration where applicable), enabling seamless claims experiences and access to cost-effective care solutions.

• Partner with stakeholders to drive claims-driven product and service innovation, leveraging ecosystem insights to enhance propositions and customer journeys.

• Support the use of data analytics and digital tools to improve ecosystem effectiveness, including provider performance monitoring, fraud detection, and customer engagement.

• Represent Claims in relevant internal and external forums or workstreams related to ecosystem development, claims innovation, and industry practices.

People Leadership & Development

• Lead and manage claims teams, including team leaders, claims specialists
• Drive team performance through effective goal setting, coaching, and development
• Build a high-performing, future-ready workforce with capabilities in digital tools and claims best practices
• Foster a culture of clarity, courage, and humanity

Minimum Job Requirements:

• Bachelor’s degree in Insurance, Business Administration, Law, Healthcare Management, or related discipline (candidates with legal background will be an advantage)
• Minimum 10–12 years of relevant experience in claims management, with strong exposure to general insurance, including at least 5 years in a supervisory or managerial capacity
• Preferably possess legal knowledge or experience in areas such as liability claims, litigation handling, policy interpretation, and dispute resolution
• Proven experience in claims operations management, including claims adjudication, process optimisation, and service delivery
• Strong track record in claims cost management, analytics, and fraud detection/mitigation
• Experience in managing external providers and legal/vendor panels
• Good understanding of regulatory requirements and compliance standards in Hong Kong
• Strong leadership, stakeholder management, and interpersonal skills
• Excellent analytical, problem-solving, and decision-making capabilities

• Strong communication skills in English and Chinese (written and spoken)

Others:

• You are preferred to obtain the license of Insurance Authority (IA) (Paper 1 and 2)
• You are required to obtain the relevant license(s) if your job involves regulated activities

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

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