The Life & Health Operations (LHO) team plays a critical role in ensuring efficient, compliant, and high-quality claims administration to support the delivery of affordable and comprehensive life and health insurance solutions. As a Claims Operations Specialist, you will support claims operations through product review, system enhancements, governance, and continuous improvement initiatives. You will act as a subject matter expert (SME) for claims processes, working closely with claims teams, business analysts, IT, and external stakeholders to ensure accuracy, efficiency, and regulatory compliance.
Key Responsibilities:
1. Product & Claims Operations Support
- Review life and medical product contracts, policy terms, and benefit specifications.
- Provide inputs for system and process enhancements related to claims administration.
- Participate in product implementation workgroups and cross-functional discussions.
- Support claim operations with technical and product-related clarifications.
2. System & Process Support
- Act as the Claims Subject Matter Expert (SME) for system-related initiatives.
- Liaise between Claims, Business Analysts, and IT teams to translate business needs into functional requirements.
Support:
- System enhancements and prioritisation
- UAT, data patches, and configuration changes
- Production issue resolution and root cause analysis
- Review impact of system changes on claims processes.
- Participate in UREQ/BSD reviews from a claims perspective.
3. Governance & Quality Assurance
- Maintain and govern claims documentation, SOPs, and work instructions.
- Ensure compliance with internal policies, regulatory requirements, and audit standards.
- Conduct peer reviews and quality checks on claims processing.
- Support claims governance and oversight of outsourced or third-party services.
4. Process Improvement & Operational Excellence
- Identify gaps and recommend improvements to claims workflows.
- Lead or participate in operational efficiency and automation initiatives.
- Support claims performance tracking, reporting, and exception management.
- Assist in planning and strategizing claims operations improvements.
5. Stakeholder Engagement
Engage and communicate effectively with:
- Claims teams and internal departments
- Financial consultants and advisers
- Reinsurers and auditors
- External stakeholders (e.g., hospitals, clinics, CPF Board)
- Conduct claims-related briefings or workshops when required.
6. Compliance & Reporting
- Support regulatory and internal compliance requirements.
- Assist with audit responses and documentation.
- Monitor claim trends, exceptions, and risk indicators.
7. Additional Responsibilities
- Support ad-hoc projects as assigned by the Section Manager or Head of Function.
- Contribute to continuous improvement and knowledge-sharing initiatives.
Requirements:
Education & Experience:
- Minimum 3-6 years of experience in Life & Health insurance claims or operations.
- Strong understanding of life and medical insurance products and claims workflows.
Technical & Functional Skills:
- Strong knowledge of claims systems and end-to-end claims processing.
- Experience working with BA/IT teams on system enhancements.
- Familiarity with governance, audit, and compliance requirements.
- Proficient in Microsoft Office (Excel, Word, PowerPoint).
- Experience with UAT, system testing, or process documentation is an advantage.
To apply,simply click the Apply button or send your updated profile to
EA Licence No.:18S9405 / EA Reg. No.:R1330864
PerceptSolutions is expanding and actively seeking talented individuals. We encourageapplicants to follow Percept Solutions on LinkedIn at https://www.linkedin.com/company/percept-solutions/to stay informed about new opportunities and events.
