Health Claims Director
Job ID: 2026-19702
Provide strategic and operational leadership for the end-to-end health claims functions, covering Fastlane, Health Screening, Outpatient and Inpatient claims. The role ensures efficient, accurate, and customer-centric claims delivery while driving cost management, fraud prevention, and digital transformation.
Duties & Responsibilities
Claims Strategy & Leadership- Develop and execute the overall health claims strategy aligned with business goals.
- Lead, mentor, and build a high performing claims organization.
- Establish governance, policies, and continuous improvement framework.
- Collaborate with Underwriting, Product & Proposition, Provider Management and Distribution teams.
A. Fastlane and Health Screening
o Lead automation and process improvement initiatives.
o Ensure rapid turnaround for eligible claims.o Oversee screening claims governance.
B. Outpatient Claims & Reimbursement
o Manage high-volume outpatient claims.
o Oversee both cashless and reimbursement processing.o Drive improvements in TAT, accuracy, and provider experience.
C. Inpatient Claims
o Oversee pre-authorization (LOA), utilization, review and final billing.
o Ensure medical necessity, cost containment, and appropriate length of stay.o Manage complex, high-value claims and escalations.
Operational Excellence and Performance Management- Establish and monitor KPIs and SLAs across all claim types.
- Drive continuous improvement, process optimization, and capacity planning.
- Implement claims governance and quality assurance frameworks.
- Ensure scalability to support business growth.
- Enhance end-to-end customer journey across all claim’s channels.
- Strengthen relationships with hospitals, clinics, and TPAs.
- Resolve escalations and improve service satisfaction.
- Monitor claims cost, loss ratios, and utilization trends.
- Identify leakages and implement cost containment initiatives.
- Strategic and enterprise thinking.
- Strong operational and execution capability.
- Stakeholder and relationship management.
- Financial and analytical acumen.
- Risk and compliance orientation.
- Change leadership and transformation.
- Bachelor’s degree in nursing, Medicine, Allied Health, Business, or related field.
- Master’s degree is an advantage.
- 12+ years’ experience in health insurance claims, with senior leadership exposure.
- Strong background in outpatient and inpatient claims adjudication.
- Health care provider management.
- Claims systems and digital transformation.
At AXA, each person matters. We perform at our best knowing the positive impact we make as valuable partners for our customers and the communities we belong to.If you want to know more about the other career opportunities at AXA Philippines, please follow this link:https://careers.axa.com/axa-entities/axa-philippines