Executive Officer, Claims

Job Description

MetLife Bangladesh is looking for an Executive Officer, Claims to manage the efficient processing, verification, investigation, assessment, and settlement of insurance claims in accordance with company policies, regulatory requirements, and service standards.

The role will also involve digital claims management, data analytics, AI-enabled tools, fraud detection, customer service, and field investigations when required.

Key Responsibilities

• Review, assess, and process insurance claims in accordance with policy provisions, company guidelines, and regulatory requirements.
• Verify claim eligibility, coverage, and supporting documentation to ensure accurate claim settlement.
• Prepare claim assessments and settlement recommendations within prescribed turnaround times.
• Escalate complex, disputed, or high-value claims to appropriate authorities.
• Conduct or support field investigations, including site visits, evidence collection, claimant interviews, and verification of claim circumstances.
• Prepare investigation reports and document findings.
• Identify and escalate suspicious, fraudulent, or high-risk claims through investigation findings and AI-based fraud indicators.
• Coordinate with investigators, healthcare providers, and relevant external stakeholders as required.
• Utilize Claims Management Systems (CMS), digital platforms, and workflow automation tools for efficient claim processing.
• Leverage AI-enabled tools to support claim assessment, fraud detection, and decision-making.
• Support digital claims submission, e-KYC verification, electronic documentation, and paperless operations.
• Identify opportunities to improve claims processes through technology, automation, and data-driven insights.
• Analyze claims data and trends to support operational efficiency and risk management.
• Prepare claims, investigation, and management reports.
• Maintain accurate claim records and documentation for audit and regulatory purposes.
• Ensure compliance with company policies, regulatory requirements, and anti-fraud standards.
• Deliver excellent customer service through timely communication and resolution of claim-related inquiries.
• Coordinate with hospitals, surveyors, investigators, service providers, and other stakeholders to facilitate claim processing and verification.
• Maintain professional relationships with internal and external stakeholders to ensure effective claim resolution.
• Contribute to a customer-centric claims experience while meeting service-level commitments.

Educational Qualification

• Bachelor’s degree in Insurance, Business Administration, Finance, Economics, Law, Data Analytics, Information Systems, or any related discipline.

Experience Requirements

• 1–3 years of experience in insurance claims, investigations, underwriting, customer service, or related insurance operations.
• Experience using digital claims management systems is preferred.

Functional Competencies

• Knowledge of insurance policies, claims processes, and regulatory requirements.
• Familiarity with Claims Management Systems (CMS).
• Understanding of AI-assisted claims processing and fraud detection tools.
• Data analysis and reporting skills.
• Proficiency in Microsoft Office Suite and business intelligence/reporting tools.

Leadership Competencies

• Thinks Strategically: Sets direction aligned with the company’s strategy, applying external and global perspectives to meet local and global needs.
• Creates Partnerships: Builds trusted relationships and collaborates across global, diverse, and multi-functional teams to drive business objectives.
• Seizes Opportunity: Seeks new opportunities and ways to create balanced business growth while improving operational capabilities.
• Models our Values: Promotes the company’s values and standards through role modeling, accountability, and ownership of decisions.
• Drives Results: Sets aggressive goals and drives improved performance, leading change and ensuring high standards.