FORTY Under 40: Joseph Mifsud Grima

Joseph Mifsud Grima, chief operating officer, Fresenius Medical Care Global Insurance.

Grima is a chartered Insurer based in Malta and has built his career on the design and management of complex multinational financial risk structures, with a particular focus on the captive insurance sector.

In this, his current role, he oversees the comprehensive underwriting and claims functions for the group’s captive entity. He is also an active member of the captive’s risk management and investment committees.

His professional approach is defined by a blend of academic focus and business leadership. He is responsible for driving business development and designing innovative insurance solutions to address insurable risks and critical coverage gaps within the global corporate framework.

Grima’s approach to the insurance industry is grounded in his academic background. He holds an MSc in finance and financial law, with distinction, from the University of London, where his research focused on the short-term impact of pandemics on bank profitability. This complements his first-class Honours degree in financial services from Edinburgh Napier University and an earlier degree in philosophy from the University of Malta.

Grima is also an Associate of the Chartered Insurance Institute (ACII) and has recently attained an international certificate in financial services risk management from the Institute of Risk Management.

Before his current appointment he spent several years as insurance manager at Vodafone Group’s captive in Malta. In this capacity, he managed the captive group’s large property and casualty (P&C) programme across several global territories.

His deep understanding of the regulatory landscape is exemplified by his work with the European Commission. As a terminology contractor, he established Maltese language equivalents for complex Solvency II definitions, ensuring linguistic and legal precision within the EU’s interactive terminology database.

Outside his profession, he is a dedicated advocate for equality and human rights. He volunteers extensively with the Malta LGBTIQ rights movement, where he focuses on sexual health and historical research.

Looking back at your journey over the past year, what accomplishment are you most proud of, and how has becoming a FORTY Under 40 finalist influenced your perspective on that achievement?

Over the past year, I am most proud of the role I played in guiding our captive operations through an important period of change. Fresh from a complex deconsolidation process, Fresenius Medical Care, the world’s leading dialysis provider, has established its own, new global insurance department. This made our Malta captive both a stabilising force and a vehicle for change. We retained critically important organisational and commercial insight, whilst also adapting to a new risk profile and mandate.

As COO of the captive, I focused on providing continuity and structure as we welcomed a new, gradually growing global insurance team, while also driving the innovation required to operate effectively in a shifting global and sectoral landscape.

In 2025, I was recognised internally as a key team player who embodies our group’s values, an achievement that was deeply meaningful to me. Becoming a FORTY Under 40 finalist has added another dimension to that recognition, prompting me to reflect not only on delivery, but on leadership impact. It reinforces the importance of setting standards, supporting others through uncertainty, and approaching complexity with fresh ideas, calm judgment and new solutions.

What key challenge did you face in your work this year? How did you overcome it and what did it teach you about leadership at this stage of your career?

One key challenge was leading the captive’s operations through significant organisational change, seeking to enhance its strategic relevance within a newly structured global insurance function. This transition required a critical reassessment of long-standing processes. We needed to determine where continuity was essential and where change was overdue, a process that remains ongoing.

Overcoming this challenge required striking a careful balance between stability and innovation amidst the need for fast decision-making. It also taught me that, as captive leaders, we must act as agents of change. Traditionally, I find that captives have tended to adhere to a proven formula, which is not inherently a negative strategy. However, captives possess a unique visibility of innovative insurance placements and alternative risk transfer strategies, often with a multinational focus, a rare combination within our industry. By leveraging this insight, we were able to drive meaningful change both within the captive and across the wider organisation and the industry.

Nevertheless, my aim is not to encourage change for its own sake. Rather, by recognising developments within the organisation, the broader industry and the global landscape, I learned we are best positioned to advance our strategy and integrate decisions within a framework that provides collective benefit.

In what ways have you tried to push innovation or rethink traditional approaches within your sector, and what impact has that had on your team or organisation?

The most prominent innovation for us this year has been technological. Driven by broader organisational changes, we identified and began implementing a new IT platform designed to modernise our insurance processes. Once fully integrated, this solution will transition the captive and our global insurance teams from legacy workflows to a more integrated data environment, improving both transparency and efficiency.

However, technological solutions do not exist in isolation. In the healthcare sector, we are constantly reminded that every decision, from a minor adjustment in insurance wording to major infrastructural shifts, must remain entirely patient-centric. This requires that every new proposal is communicated clearly to the internal team and to stakeholders responsible for important aspects of our healthcare delivery and enablement, from respecting our patients’ right to privacy, to aligning the insurance strategy with wider corporate goals.

A key component of this transition has been ensuring a unified approach, which requires tailoring our communication and support to meet the diverse needs across all teams. Over the past year, my peers and I have focused on bringing the team on board without compromising project timelines. This drive for modernising our insurance function has begun to influence the wider organisation, fostering a culture that views insurance not just as a back-office necessity, but as a proactive partner in the group’s overarching mission. This is an achievement I wish to share with all my colleagues, both those who have navigated this transition with me from the start and those who have joined our evolving team.

Captives possess a unique visibility of innovative insurance placements and alternative risk transfer strategies, often with a multinational focus, a rare combination within our industry.

How do you see your role evolving over the next three to five years, and what initiatives are you most excited to pursue as you continue to grow professionally?

Having used the momentum of 2025 to propel us into 2026, I see my role evolving into one of deeper strategic integration. With the captive firmly embedded in the decision-making process, we are positioned to leverage the flexibility and innovation that only a captive structure can offer. As I have already noted, change for its own sake is counterproductive, and to avoid this, I intend to ensure that my contributions continue to be rooted in a foundation of technical understanding and empirical evidence.

It is a long-standing joke among my peers that I am a perpetual student, but like all good humour, it is rooted in reality. Over the next three to five years, I plan to further my formal studies and bring that spirit of exploration into my professional life. By staying at the intersection of academic research and industry innovation, particularly in fintech, AI and the evolving regulatory landscape, I intend to ensure the captive remains at the vanguard of the industry.

For me, this journey is both professional and deeply personal. I am excited to continue growing alongside an organisation that values informed, forward-thinking leadership as much as I value the pursuit of knowledge.

Many of the FORTY Under 40 winners are recognised for both business success and broader impact – how do you balance professional excellence with contributions to your community or industry landscape?

I feel that professional excellence and community contribution are not separate pursuits but parts of the same responsibility. The discipline and judgement I apply in business are the same qualities I bring to voluntary work, while the empathy and perspective gained from community engagement fundamentally shapes how I lead. In an increasingly polarised environment, I believe professionals have a collective duty to contribute beyond their immediate roles, whether by sharing technical expertise or dedicating time to organisations that improve the lives of others.

My involvement in voluntary work began around seven years ago when a friend mentioned that a leading LGBTIQ+ organisation in Malta was struggling to understand its insurance obligations. What started as practical guidance evolved into a deeper commitment, from resolving the insurance issues to serving as treasurer for several years and leading a series of meaningful projects.

During this journey, I recognised a critical gap in the understanding of sexual health, both within the community and among medical professionals in my country. Collaborating with volunteers from diverse professional and personal backgrounds, I launched and led an initiative comprising online resources, workshops and conferences designed to bridge the gap between clinical practice and lived experience. Following several discussions with key stakeholders, we secured updates to the national drug formulary and improved the diagnostic and treatment pathways within the national healthcare service.

Recognition such as FORTY Under 40 is an honour, but it also reinforces a duty to use our expertise with purpose and to build organisations that are not only commercially successful but fairer and more responsive to the people they serve.

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