26 Healthcare Claims jobs in Malaysia

Executive, Customer Promise - Healthcare Claims

Location: Kuala Lumpur | Type: Full-time | Posted: 3 Days Ago | Requisition ID: 25040440

Prudential’s purpose is to be partners for every life and protectors for every future. Our culture celebrates diversity and inclusion, supporting our people’s growth and career ambitions. We aim to create a workplace where you can Connect, Grow, and Succeed.

Principal Duties & Responsibilities:

1. Adhere to claim workflow procedures related to hospitalization claims.
2. Assess and approve claims based on policy terms and conditions.
3. Approve claims within department benchmarks and authority limits; recommend approval or repudiation.
4. Respond promptly to customer inquiries from all sources using appropriate communication channels.
5. Monitor claims processing benchmarks and turnaround times.
6. Coordinate daily operations and correspondence within the department and with other departments.
7. Handle incoming inquiries via email, phone, and portal from internal and external parties.
8. Prepare and submit reports as required by management within service standards.
9. Collaborate with IT to troubleshoot operational issues.
10. Review and update administrative procedures for efficiency.
11. Participate in training for personal and professional development.
12. Undertake projects or tasks assigned by management.
13. Ensure compliance with FSA, Bank Negara Malaysia regulations, AML/CFT efforts, LIAM guidelines, and internal policies.

Prudential is an equal opportunity employer. We provide benefits and opportunities regardless of sex, race, age, ethnicity, education, social background, marital status, pregnancy, religion, disability, or employment status. Reasonable adjustments are available for individuals with specific health requirements.

#J-18808-Ljbffr

Senior Manager, Customer Promise - Healthcare Claims

Join to apply for the Senior Manager, Customer Promise - Healthcare Claims role at Prudential Assurance Malaysia Berhad

Senior Manager, Customer Promise - Healthcare Claims

Join to apply for the Senior Manager, Customer Promise - Healthcare Claims role at Prudential Assurance Malaysia Berhad

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.

The incumbent is responsible to manage an efficient and effective Claims team by meeting and exceeding management’s expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer’s enquiries are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.

Position Summary

Lead and manage the overall Claims Section Operations, to drive operational excellence across all claims handling activity

Planning of staff roster for 24/7 Operation team

Planning overall strategy of the Unit

Managing the day to day functions of the Unit which include people, system, procedures and others.

Principal Duties & Responsibilities

Appraising claims up to a company-specified approval limit.

Strategic planning, managing, coordinating, controlling and monitoring the Unit plans to ensure that the operational objectives of the department and the company are being met.

Responsible in ensuring appropriate measures and controls on claims leakages and fraud management, monitoring of legal cases are adhered to.

Assessing critical legal and industry issues on claims with high ambiguity and exposures to the company.

Ensuring that Insurance Act, Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.

Applying complicated theory and fundamentals of claims appraisals.

Ensuring company-specific claims policy and guidelines are in line with Prudential Malaysia Claims policy and standards. This includes defining and implementing standards for accuracy, productivity and timeliness as well as recommending strategies to meet those standards.

Reviewing and revising claims guidelines regularly to ensure that they are aligned with changes in the market, legal and regulatory environments, and product design.

Supervising the performance of subordinates.

Representing the department head in meetings.

Implementing projects for the streamlining of operations or improvement of servicing capabilities.

Determining appropriate training for subordinates to ensure that they are keeping up with market and business requirements.

Maintain effective relationships with key stakeholders and collaborate with across business units to provide claims input into business decisions, budgeting process etc.

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.

Seniority level

• Seniority level Mid-Senior level

Employment type

• Employment type Full-time

Job function

• Job function Health Care Provider

Referrals increase your chances of interviewing at Prudential Assurance Malaysia Berhad by 2x

Get notified about new Healthcare Manager jobs in Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia .

Senior Brand Manager (Healthcare / FMCG)

Petaling Jaya, Selangor, Malaysia 1 day ago

Business Consulting (Healthcare), Manager/Senior Manager

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 days ago

Petaling Jaya, Selangor, Malaysia 4 days ago

Manager, Provider Management & Connected Care

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 day ago

Senior Manager, Specialist & Quality Audit Management and Advisory

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Petaling Jaya, Selangor, Malaysia 5 days ago

Petaling Jaya, Selangor, Malaysia 1 day ago

Market Access and Healthcare Affairs Manager

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 4 weeks ago

Medical Advisory, Case & Fraud Management, Specialist

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Business Manager - Ultrasound (Indonesia & Malaysia)

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago

Federal Territory of Kuala Lumpur, Malaysia 1 week ago

DRSC Assurance - Internal Audit (Life Science & Healthcare) - Consultant / Senior Consultant

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 6 days ago

Country Heights Damansara, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago

Senior Manager - Business Development, Sterile Goods Management (based in KL)

Federal Territory of Kuala Lumpur, Malaysia 1 day ago

Federal Territory of Kuala Lumpur, Malaysia 2 days ago

Petaling Jaya, Selangor, Malaysia 1 month ago

DRSC Assurance - Internal Audit (Life Science & Healthcare) - Consultant / Senior Consultant

Taman Wilayah, Federal Territory of Kuala Lumpur, Malaysia 5 days ago

Federal Territory of Kuala Lumpur, Malaysia 3 weeks ago

Kuala Lumpur City, Federal Territory of Kuala Lumpur, Malaysia 37 minutes ago

Business Analyst, Consultant/Principal (Product Manager)

Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago

Manager - Business Development (Sutures & Biosurgical) - APAC Regional Asst Manager - Business Development (Acute Therapies)

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 11 hours ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 3 weeks ago

Federal Territory of Kuala Lumpur, Malaysia 1 day ago

Petaling Jaya, Selangor, Malaysia 1 day ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

#J-18808-Ljbffr

Senior Manager, Customer Promise - Healthcare Claims

Join to apply for the

Senior Manager, Customer Promise - Healthcare Claims

role at

Prudential Assurance Malaysia Berhad Senior Manager, Customer Promise - Healthcare Claims

Join to apply for the

Senior Manager, Customer Promise - Healthcare Claims

role at

Prudential Assurance Malaysia Berhad 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.

The incumbent is responsible to manage an efficient and effective Claims team by meeting and exceeding management’s expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer’s enquiries are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.

Position Summary

Lead and manage the overall Claims Section Operations, to drive operational excellence across all claims handling activity

Planning of staff roster for 24/7 Operation team

Planning overall strategy of the Unit

Managing the day to day functions of the Unit which include people, system, procedures and others.

Principal Duties & Responsibilities

Appraising claims up to a company-specified approval limit.

Strategic planning, managing, coordinating, controlling and monitoring the Unit plans to ensure that the operational objectives of the department and the company are being met.

Responsible in ensuring appropriate measures and controls on claims leakages and fraud management, monitoring of legal cases are adhered to.

Assessing critical legal and industry issues on claims with high ambiguity and exposures to the company.

Ensuring that Insurance Act, Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.

Applying complicated theory and fundamentals of claims appraisals.

Ensuring company-specific claims policy and guidelines are in line with Prudential Malaysia Claims policy and standards. This includes defining and implementing standards for accuracy, productivity and timeliness as well as recommending strategies to meet those standards.

Reviewing and revising claims guidelines regularly to ensure that they are aligned with changes in the market, legal and regulatory environments, and product design.

Supervising the performance of subordinates.

Representing the department head in meetings.

Implementing projects for the streamlining of operations or improvement of servicing capabilities.

Determining appropriate training for subordinates to ensure that they are keeping up with market and business requirements.

Maintain effective relationships with key stakeholders and collaborate with across business units to provide claims input into business decisions, budgeting process etc.

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. Seniority level

Seniority level Mid-Senior level Employment type

Employment type Full-time Job function

Job function Health Care Provider Referrals increase your chances of interviewing at Prudential Assurance Malaysia Berhad by 2x Get notified about new Healthcare Manager jobs in

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia . Senior Brand Manager (Healthcare / FMCG)

Petaling Jaya, Selangor, Malaysia 1 day ago Business Consulting (Healthcare), Manager/Senior Manager

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 days ago Petaling Jaya, Selangor, Malaysia 4 days ago Manager, Provider Management & Connected Care

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 day ago Senior Manager, Specialist & Quality Audit Management and Advisory

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago Petaling Jaya, Selangor, Malaysia 5 days ago Petaling Jaya, Selangor, Malaysia 1 day ago Market Access and Healthcare Affairs Manager

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 4 weeks ago Medical Advisory, Case & Fraud Management, Specialist

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago Business Manager - Ultrasound (Indonesia & Malaysia)

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago Federal Territory of Kuala Lumpur, Malaysia 1 week ago DRSC Assurance - Internal Audit (Life Science & Healthcare) - Consultant / Senior Consultant

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 6 days ago Country Heights Damansara, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago Senior Manager - Business Development, Sterile Goods Management (based in KL)

Federal Territory of Kuala Lumpur, Malaysia 1 day ago Federal Territory of Kuala Lumpur, Malaysia 2 days ago Petaling Jaya, Selangor, Malaysia 1 month ago DRSC Assurance - Internal Audit (Life Science & Healthcare) - Consultant / Senior Consultant

Taman Wilayah, Federal Territory of Kuala Lumpur, Malaysia 5 days ago Federal Territory of Kuala Lumpur, Malaysia 3 weeks ago Kuala Lumpur City, Federal Territory of Kuala Lumpur, Malaysia 37 minutes ago Business Analyst, Consultant/Principal (Product Manager)

Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago Manager - Business Development (Sutures & Biosurgical) - APAC Regional

Asst Manager - Business Development (Acute Therapies)

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 11 hours ago Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 3 weeks ago Federal Territory of Kuala Lumpur, Malaysia 1 day ago Petaling Jaya, Selangor, Malaysia 1 day ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

#J-18808-Ljbffr

Job Summary

Under moderate supervision, manages single and multi-party personal or commercial line claims of low to moderate exposure and complexity within specified authority limits. Follows established protocols to ensure efficient and effective claims handling while providing customer-centric service.

Key Responsibilities:

• Accurately document claims by capturing and updating data.
• Determine liability through fact-gathering and analysis.
• Assess and confirm policy coverage.
• Develop case strategies for timely resolution, escalate issues as needed.
• Establish and review reserves throughout the claims process within authority limits.
• Evaluate damages.
• Negotiate settlements with appropriate strategies.
• Maintain quality standards by adhering to best practices.
• Proactively communicate with customers, respond to inquiries, and follow protocols aligned with Claims Vendor Management strategy.
• Ensure compliance with laws, regulations, and internal controls.
• Refer claims to subrogation and fraud teams when applicable.
• Contribute insights and trends to support profitable growth.
• Protect the company's reputation by maintaining confidentiality of claims information.
• Stay informed on industry trends and participate in professional networks and societies.

Qualifications:

Required:

• Diploma or degree in insurance, business, law, or related field preferred.

Preferred:

• Strong analytical and decision-making skills.
• High attention to detail and accuracy.
• Effective communication and negotiation skills.
• Ability to manage multiple claims and meet deadlines.
• Customer-focused with empathy and professionalism.

Join us at Zurich!

We value innovative thinking and encourage growth. Explore opportunities within Zurich to advance your career. Let’s grow together!

Additional Details:

• Location: Kuala Lumpur, MY
• Schedule: Full Time
• Recruiter: Eilma Fatehah Sabri

#J-18808-Ljbffr

Job Summary Under moderate supervision, manages single and multi-party personal or commercial line claims of low to moderate exposure and complexity within specified authority limits. Follows established protocols to ensure efficient and effective claims handling while providing customer-centric service. Key Responsibilities: Accurately document claims by capturing and updating data. Determine liability through fact-gathering and analysis. Assess and confirm policy coverage. Develop case strategies for timely resolution, escalate issues as needed. Establish and review reserves throughout the claims process within authority limits. Evaluate damages. Negotiate settlements with appropriate strategies. Maintain quality standards by adhering to best practices. Proactively communicate with customers, respond to inquiries, and follow protocols aligned with Claims Vendor Management strategy. Ensure compliance with laws, regulations, and internal controls. Refer claims to subrogation and fraud teams when applicable. Contribute insights and trends to support profitable growth. Protect the company's reputation by maintaining confidentiality of claims information. Stay informed on industry trends and participate in professional networks and societies. Qualifications: Required: Diploma or degree in insurance, business, law, or related field preferred. Preferred: Strong analytical and decision-making skills. High attention to detail and accuracy. Effective communication and negotiation skills. Ability to manage multiple claims and meet deadlines. Customer-focused with empathy and professionalism. Join us at Zurich! We value innovative thinking and encourage growth. Explore opportunities within Zurich to advance your career. Let’s grow together! Additional Details: Location: Kuala Lumpur, MY Schedule: Full Time Recruiter: Eilma Fatehah Sabri

#J-18808-Ljbffr

This role involves directing, monitoring, assessing and handling Financial Lines claims (including but not limited to Directors’ & Officers’ Liability, Professional Indemnity, Employment Practices Liability, Bankers Blanket Bonds / Financial Institutions Professional Liability, Medical Malpractice, Cyber claims), and includes all ancillary tasks such as updating of claims management systems, internal reporting, participating in training relevant to the role, etc. The candidate must also be able to manage and handle all type of Liability Claims including Casualty Claims.

This position is accountable for :-

(i) Claims Service

(ii) Claims Quality

(iii) Claims Reporting

(iv) Expense Management

Major duties and responsibilities

Work within local and regional operating processes and claim handling procedures to ensure that quality claim service is rendered to all internal and external stakeholders in accordance with Chubb claims philosophy and Best Practices.

Effectively manage Financial Lines claims underwritten and reported in Malaysia, in particular, D&O, EPL, PI, Medmal and Cyber claims, against policy terms and conditions, company guidelines, local operating procedures and claims management guidelines.

Effectively collaborate with claims technical supervisors regionally through the preparation of high-quality claims referrals that allow for accurate and appropriate claims handling decisions to be made.

Ensure proper and timely reserving within established standards.

Collate claims information and data as required for internal and external reporting purposes, including verifying completeness and accuracy of reports.

Attend to claim enquiries and feedback, maintain positive relationship with all internal and external customers, including underwriters, actuaries, brokers/agents and service providers.

Recommend and/or settle claims per policy. In cases of ex-gratia requests, fully brief the Head of Claims

Ensure and provide fast, efficient and courteous claims service to all customers within the customer service guidelines and standards established by Head of Claims.

Work with internal colleagues to manage accounts, contribute effectively to discussions with business units in respect of product development and loss control.

Ensure that appropriate management (whether within Claims or the wider business) and underwriters are made aware on a timely basis of large losses and specific claims issues or trends which may impact underwriting decisions.

Manage and supervise claims to finality within designated authority and in accordance with Chubb claims management guidelines and Best Practices.

Ensure that loss reserves are set, reviewed and revised or maintained in accordance with Chubb guidelines.

Provide timely updates of claims data into systems and ensure correctness of data entry into systems and file records.

Document and collate Financial Lines claims processes and controls.

Use external resources in accordance with Chubb guidelines and philosophies. This includes the engagement of, or direction for the engagement of, appropriate service providers/vendors where required and the active management of such providers, to ensure focus on the timely and effective resolution of Financial Lines claims.

Be aware of the constant drive to improve productivity and recommend modifications and improvements to established procedures.

This position may develop to include other tasks, which are commensurate with the employee’s abilities, in addition to those recorded in this Role Description.

Qualifications

Skills

Excellent written and verbal communication skills in English and Bahasa Melayu

High degree of attention to detail and excellent analytical skills

Effective negotiation and interpersonal skills and ability to collaborate with all internal and external stakeholders

Proactive and flexible approach to work

Approachable and friendly attitude

Ability to work autonomously, employ initiative to find solutions, priorities and exercise discretion

Excellent organizational and administration skills

Willingness to continuously learn and improve technical skills

Technical competence with Microsoft software packages, especially Outlook, Word, Excel and PowerPoint

Education & Experience

Diploma or Bachelor's degree or equivalent in Law or Legal Studies preferred.

2 years or more of experience in Financial Lines and/or Liability claims handling.

Added experience in legal practice is an advantage.

Job Info

• Job Identification 24497
• Job Schedule Full time
• Regular or Temporary Regular
• Job Category Claims Adjusting
• Business Unit Malaysia

#J-18808-Ljbffr

Key Objective

• This role involves directing, monitoring, assessing and handling Financial Lines claims (including but not limited to Directors’ & Officers’ Liability, Professional Indemnity, Employment Practices Liability, Bankers Blanket Bonds / Financial Institutions Professional Liability, Medical Malpractice, Cyber claims), and includes all ancillary tasks such as updating of claims management systems, internal reporting, participating in training relevant to the role, etc. The candidate must also be able to manage and handle all type of Liability Claims including Casualty Claims.

• This position is accountable for :-

  (i) Claims Service

  (ii) Claims Quality

  (iii) Claims Reporting

  (iv) Expense Management

Major duties and responsibilities

• Work within local and regional operating processes and claim handling procedures to ensure that quality claim service is rendered to all internal and external stakeholders in accordance with Chubb claims philosophy and Best Practices.

• Effectively manage Financial Lines claims underwritten and reported in Malaysia, in particular, D&O, EPL, PI, Medmal and Cyber claims, against policy terms and conditions, company guidelines, local operating procedures and claims management guidelines.

• Effectively collaborate with claims technical supervisors regionally through the preparation of high-quality claims referrals that allow for accurate and appropriate claims handling decisions to be made.

• Ensure proper and timely reserving within established standards.

• Collate claims information and data as required for internal and external reporting purposes, including verifying completeness and accuracy of reports.

• Attend to claim enquiries and feedback, maintain positive relationship with all internal and external customers, including underwriters, actuaries, brokers/agents and service providers.

• Recommend and/or settle claims per policy. In cases of ex-gratia requests, fully brief the Head of Claims

• Ensure and provide fast, efficient and courteous claims service to all customers within the customer service guidelines and standards established by Head of Claims.

• Work with internal colleagues to manage accounts, contribute effectively to discussions with business units in respect of product development and loss control.

• Ensure that appropriate management (whether within Claims or the wider business) and underwriters are made aware on a timely basis of large losses and specific claims issues or trends which may impact underwriting decisions.

• Manage and supervise claims to finality within designated authority and in accordance with Chubb claims management guidelines and Best Practices.

• Ensure that loss reserves are set, reviewed and revised or maintained in accordance with Chubb guidelines.

• Provide timely updates of claims data into systems and ensure correctness of data entry into systems and file records.

• Document and collate Financial Lines claims processes and controls.

• Use external resources in accordance with Chubb guidelines and philosophies. This includes the engagement of, or direction for the engagement of, appropriate service providers/vendors where required and the active management of such providers, to ensure focus on the timely and effective resolution of Financial Lines claims.

• Be aware of the constant drive to improve productivity and recommend modifications and improvements to established procedures.

• This position may develop to include other tasks, which are commensurate with the employee’s abilities, in addition to those recorded in this Role Description.

Qualifications

Skills

• Excellent written and verbal communication skills in English and Bahasa Melayu

• High degree of attention to detail and excellent analytical skills

• Effective negotiation and interpersonal skills and ability to collaborate with all internal and external stakeholders

• Proactive and flexible approach to work

• Approachable and friendly attitude

• Ability to work autonomously, employ initiative to find solutions, priorities and exercise discretion

• Excellent organizational and administration skills

• Willingness to continuously learn and improve technical skills

• Technical competence with Microsoft software packages, especially Outlook, Word, Excel and PowerPoint

Education & Experience

• Diploma or Bachelor's degree or equivalent in Law or Legal Studies preferred.

• 2 years or more of experience in Financial Lines and/or Liability claims handling.

• Added experience in legal practice is an advantage.

#J-18808-Ljbffr

ABOUT US

‘First’ is more than our name, it’s our nature. Cayman First is an industry-leading Property & Casualty and Health insurer, delivering best-in-class products and services to respond to the changing needs of individuals, households and businesses. Through our carefully selected network of agents and brokers, we provide protection for our customers today and prepare them for a brighter tomorrow. Cayman First maintains an A- (Excellent) financial strength rating from global credit rating agency AM Best.

PURPOSE OF JOB

As a Claims Examiner for our Property and Casualty division, you will be responsible for collecting and verifying claim information, maintaining accurate records, and updating claims files in the Claims Management Software. You will assist with various claim types, handle client inquiries, and ensure high levels of customer service. Additional responsibilities include reviewing claims with claimants, authorizing repairs, liaising with external agencies, and supporting the efficient operation of the First Response Unit.

This is a great opportunity for someone with a passion for customer service, who would like to work in the insurance industry. Here at Cayman First Insurance, we offer a supportive environment that encourages collaboration fosters professional growth.

JOB RESPONSIBILITIES

• Collect and record accurate information and documents from walk-in, electronic, or virtual clients, forwarding them to the Claims Manager for review and assignment.
• Maintain the New Claims Register and ensure motor claims are properly registered.
• Contact agencies to verify coverage details and submit findings to the relevant Adjuster or Claims Manager.
• Review and update claims files in the Claims Management Software, ensuring they remain accurate and up to date.
• Assist with various claim types, including subrogation, marine claims, non-motor claims, and inspections of damaged vehicles, as instructed.
• Handle telephone calls, emails, and correspondence regarding general inquiries, customer complaints, or communications with other insurance companies, ensuring a high level of customer service.
• Review claims with claimants, discuss settlements, and authorize vehicle repairs as directed.
• Liaise with police authorities and maintain an effective follow-up and diary management system for claims.
• Vet customer complaints and work with the Claims Manager to ensure timely resolution.
• Render assistance to ensure the efficient operation of the First Response Unit and complete other duties as assigned.
• Complete additional duties as assigned by management.

• High School Diploma or relevant Associates Degree.
• Possess a minimum of three years’ experience in the insurance industry.
• Analyze and adjudicate claims in accordance with contract provisions and standard business practices.
• Manage time and workload effectively to meet productivity targets and deadlines with minimal supervision.
• Apply strong analytical skills and attention to detail when reviewing claim information and documentation.
• Actively pursue an Insurance Certificate such as CII or equivalent professional qualification.
• Communicate effectively through clear written, verbal, and listening skills.
• Build and maintain positive working relationships through strong interpersonal abilities.
• Deliver excellent customer service by addressing inquiries and resolving issues professionally.

Cayman First offers a competitive compensation package with eligibility for a discretionary bonus, subsidized health insurance for employees and dependents, preferred home and motor insurance, a great company culture and work life balance. Compensation will be commensurate with experience and qualifications.

#J-18808-Ljbffr

Job Summary

Engage proactively in projects to improve processing efficiency and enhance system functionalities. Additionally, process Non-motor claims, including Property, Marine Hull, Marine Cargo, Personal Accident (PA), Liability, and Health & Safety (H&S).

Responsibilities

1. Identify and propose enhancements for processing and system functionalities of Non-motor Claims to ensure effective claims processing.
2. Collaborate with IT, vendors, and end-users across departments to define requirements, testing scopes, and execute user acceptance tests for system enhancements.
3. Evaluate, process, and manage insurance claims to ensure accuracy, policy adherence, and timely resolution, including:
1. Claim review: Analyze claims for coverage eligibility, policy terms, and deductibles.
2. Documentation: Gather and review claim documents such as incident reports, medical records, and evidence.
3. Coverage determination: Assess policy coverage scope and limitations.
4. Adjudication: Make final decisions on claim settlements based on policy and investigation results.
5. Negotiation: Settle claims through negotiations with claimants and stakeholders.
6. Communication: Update claimants, policyholders, and agents on claim status and inquiries.
7. Fraud detection: Identify and flag potentially fraudulent claims.
8. Customer service: Provide quality support and guidance throughout the claims process.
4. Monitor outstanding claims files and ensure proper management by service providers such as adjusters, surveyors, and lawyers.
5. Address claims-related queries and discussions with customers, agents, brokers, sales, and other stakeholders.
6. Provide claims insights to support business acquisition and product development, and conduct claims training for stakeholders as needed.

Qualifications

• Bachelor’s Degree or equivalent in any related field.
• Fresh graduates are welcome to apply.
• Experience in system enhancement projects within financial institutions is advantageous.
• Experience in claim processing is advantageous.
• Ability to work independently and as part of a team.
• Good communication skills.
• Ability to leverage AI tools like ChatGPT for data analysis and insights.

Disclaimer

Thank you for your interest. Due to high application volume, we cannot provide individual feedback. If you do not hear from us within 14 days, please assume you have not been selected. All updates will be communicated via email. Allianz does not accept unsolicited resumes from external sources except directly from candidates. We are committed to diversity and inclusion in our workforce.

Join Us

We believe in a diverse, inclusive environment where everyone can grow and contribute. Together, let's build a better future for our customers and the world.

#J-18808-Ljbffr