Manager, Claims

3 days ago Be among the first 25 applicants Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed. This is a high-impact leadership role responsible for driving claims operational excellence and fraud intelligence across Life and Health insurance portfolios. As Manager of Claims & FWA Data Analytics, you will lead the design and execution of data-driven strategies to optimize claims performance, monitor operational KPIs, and proactively detect and mitigate fraud, waste, and abuse. You will be a trusted advisor to Claims, Risk, Legal, and Technology teams, enabling transformation through analytics, automation, and governance. Why This Role Is Elite Dual Domain Leadership: Shape both claims strategy and fraud intelligence for Life & Health portfolios. Operational Impact: Direct influence on claims efficiency, customer satisfaction, and cost containment. Innovation-Driven: Lead the adoption of AI/ML in claims adjudication and fraud detection. Strategic Visibility: High-impact role with direct reporting to senior leadership and regulators. Job Responsibilities 1. Claims Operations Analytics Monitor and analyze key operational metrics including Turnaround Time (TAT), Straight-Through Processing (STP) rates, First-Time Resolution, and Cost per Claim. Develop and maintain performance dashboards for Claims leadership to track service levels, efficiency, and customer experience. Identify bottlenecks and recommend process improvements to enhance claims adjudication speed and accuracy. 2. FWA Detection & Prevention Design and deploy predictive models and rule-based engines to detect suspicious claims behaviors and fraud typologies. Lead analytics support for Special Investigation Unit (SIU), Legal, and Compliance teams. Quantify financial impact of FWA cases and support recovery and litigation efforts. 3. Strategic Claims Insights Analyze claims trends across Life and Health products to identify leakage, inefficiencies, and improvement opportunities. Provide actionable insights to Claims leadership on provider behavior, customer patterns, and operational risks. Support strategic initiatives such as claims automation, digital adjudication, and benefit optimization. 4. Data Infrastructure & Technology Enablement Collaborate with IT and Data Engineering to build scalable data pipelines and analytics platforms. Evaluate and integrate third-party tools (e.g., OCR/NLP for document processing, fraud scoring engines, consortium databases). 5. Governance, Compliance & Reporting Ensure analytics processes comply with Hong Kong Insurance Authority (IA) regulations and internal audit standards. Prepare executive-level reports and regulatory submissions on claims performance and fraud risk. 6. Leadership & Collaboration Mentor junior analysts and foster a high-performance analytics culture. Lead cross-functional task forces on claims transformation, fraud prevention, and regulatory readiness. Represent the company in industry forums and consortiums on claims analytics and fraud intelligence. Job Requirements Bachelor’s or Master’s degree in Data Science, Actuarial Science, Statistics, Insurance, or related field. 6–10 years in Life & Health insurance claims analytics, with deep exposure to both operational and fraud domains. Proven track record in driving claims transformation through data. Experience in managing claims KPIs, STP initiatives, and fraud detection programs. Advanced proficiency in Python, R, SQL, Power BI/Tableau. Experience with machine learning, NLP, and automation tools. Familiarity with claims systems (e.g., Guidewire, Duck Creek) and cloud platforms (Azure, AWS). Preferred Certifications: Certified Fraud Examiner (CFE), ACII / FLMI / CPCU, Data Science or AI certifications. Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part‑time / fixed‑term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third‑party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements. #J-18808-Ljbffr