Team Head

The Claims Team Head is primarily responsible in overseeing the claims processing and operational
activities of the assigned Team. Ensures efficient claims processing of assigned team through equitable
settlement of claims filed at the soonest possible time based on insurance policy coverage and
conditions. Assists Claims Unit Head in developing strategies for better processes and procedures in
relation to claims processing and client servicing. Monitors Claims Officers and/or Claims Assistants
and ensures their compliance to company policies and procedures.
The following are the detailed duties and responsibilities of the Claims Team Head:
A. Claims Processing
1. Receives settlement offers/ Letter of Authorities (LOA) and check if equitably evaluated.
2. Reviews insurance policies and conditions of the claim.
3. Reviews basis of claim denial and:
i. negotiates/contests with insurers/adjusters if necessary or
ii. explains the basis of denial to client/claimant
4. Informs Claims Unit Head or Senior Management of any issues, circumstances or technicality
that may affect the processing or settlement of claims being processed.
5. Discusses claims issues and concerns with Insurers/ Adjusters.
6. Conducts claims orientation to clients as required by Marketing Units.
7. Discusses claim issues and concerns to reconcile status of claims with the client.
8. Entertains calls/inquiries from clients/claimants, insurers, adjusters, BDO Branches and other
concerned parties.
9. Joins Insurer/ Adjuster during claims inspections and meetings if necessary to protect the
interest of the client.
10. Updates clients/ claimants on the status of the claim.
11. Complies with the agreed claims procedures and/ or specific work instructions in handling
claims.
B. Management of Assigned Team
1. Oversees the functions of the Team.
2. Checks non-standard letters, reports and other documents prepared by the team.
3. Ensures that the work done by the team is within the scope of the following:
i. job descriptions
ii. in accordance to the broking procedures
iii. and specific claims policies and procedures of the section
C. Strategy and Team Development
1. Oversees the functions of the assigned team.
2. Monitors the effectiveness of existing policies and procedures and recommends to Claims Unit
Head possible revisions or new strategies for better claims processing and client servicing.
3. Coordinates with other Claims Team Heads and Team Leads best practices and provide joint
recommendation to Claims Unit Head.
4. Ensures continuous development of the team by participating in both in-house and external
training.
D. Other Functions
1. Prepares documentation other than standard claim letters and reports as required by other
units, Claims Unit Head or Senior Management.
2. Performs other related functions/tasks as may be assigned from time to time by the Claims
Unit Head or Senior Management.