What Jobs are available for Insurance in Malaysia?

**JOB PURPOSE**
**The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.**
**RESPONSIBILITIES AND DUTIES**
+ Processes claims from members and providers.
+ Assists queries from providers and payers via phone calls or e-mails.
+ Maintains files for authorizations and other reports.
+ Assesses and processes claims in line with the policy coverage and medical necessity.
+ Be fully versed with medical insurance policies for various groups / beneficiaries.
+ May assist in training colleagues and asked to share knowledge.
+ Accurately assesses eligibility within the policy boundaries.
+ Monitors and maintains the claims processing as per the defined terms and policy of the organization.
+ Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis.
+ Monitors the qualitative and quantitative measures for claims & pre-approvals.
+ Ensures compliance to any changes in terms of system parameters or process.
+ Maintains quality as per framework for accuracy.
+ Maintains productivity and responsiveness to the work allocated.
+ Collaborate with other stakeholders / teams to resolve queries including complex queries.
+ Actively support all team members to enable operational goals to be achieved.
+ Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).
+ Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.
+ Accurate data input to the system applications.
+ Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods.
+ Following up own workload (volume and timing): keeping an eye on chronology and processing time of the work volume and taking suitable actions.
+ Participate efficiently in processing the flow of claims: inform the supervisor about claims lacking clarity and about possible ways of optimizing the processes.
+ A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactions are important motivators.
+ Monitor and highlight high-cost claims and ensure relevant parties are aware.
+ Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication.
+ Adjust error claims according to actual situation.
+ Well handle recoupment and reconciliation work, communicate with providers and members via call and email for collection and explanation.
+ Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly.
+ Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved
**KNOWLEDGE, SKILLS AND EXPERIENCE**
+ At least 1-2 years of experience performing a similar role.
+ Experience of working for an international company, preferred but not essential.
+ Claims processing or insurance experience, preferred but not essential.
+ Broad awareness of medical terminology, advantageous.
+ Excellent organizational skills, capable of following and contributing to agreed procedure.
+ Strong administration awareness and experience, essential.
+ Strong skills in Microsoft Office applications, essential.
+ First class written and verbal communication skills, essential.
+ Ability to communicate across a diverse population, essential.
+ Capable of working independently, or as part of a team.
+ Good time management, ability to work to tight deadlines.
+ Flexible and adaptable approach, sometimes working in a fast-paced environment.
+ Passion for achieving agreed objectives.
+ Confident in calling out when facing issues.
+ Should be flexible to work in shifts and on staggered weekends for overtime.
**COMMUNICATIONS AND WORKING RELATIONSHIPS**
The job holder must ensure building strong effective relationships with all his matrix partners and demonstrating approachability and openness. He/ She must be able to foster strong internal and external communication standards.
**About The Cigna Group**
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

As a supervisor you will support the team manager in managing a team of Claims Analysts. Key to the role will be developing and coaching the team to deliver a high quality customer centric service offering. Your role includes:
 Accountable to review and assess inventory levels coordinating daily allocations and planning ahead to maximise staffing levels to maximise results.
Accountable to ensure that productivity, quality and customer satisfaction, are managed within own team and motivation of the individuals and team to achieve the operational KPI's; Attend KPI calls can help you to achieve this.
ecommending and implementing innovative strategies to improve efficiency and provide excellent customer service
eing proactive in identifying improvement/enhancement opportunities and be active in seeking and sharing ideas for innovation in business processes.
eing responsible for follow-up of capacity planning and absences in close cooperation with HR
nsure strong employee engagement within the team, including day to day oversight, motivation, conflict management, training, well being and performance by providing coaching and skill development in collaboration with the Claims Management Team.
nsure appropriate performance management actions are taken
aving quarterly check-in conversations with all team members
romote a culture of continuous improvement and be fully responsible for the implementation of new ways of working and the measurement of the results in alignment with the broader Claims Strategy and in coordination with the Management Team
aking ownership of any escalated claims and provide updates to the Team manager on any issues
roactively address and/or escalate any operational risks to the team Manager
eveloping/maintaining proactive/effective business relationships, both internally and externally to ensure a seamless delivery of service. Actively encourage all team members to do likewise (e.g. Cigna links).Option to take over SPOC role for particular clients/accounts if required
e Represent the Organisation during client visits, absences, stakeholder meetings, or act as a relationship person towards some our strategic partners.
ogether with the SME, you are responabible and accountable for the implementation of new clients/renewals/changes for existing clients that belong to your book of business
rocess claims or support the financial verification
**YOUR PROFILE**
to 3 years of leadership experience in healthcare medical claims industry, or relevant in other functions/companies.
trong performance track record
nternational mind-set, with holistic and able to work remotely with peers across locations
xperience in and passion for coaching, managing, developing and motivating individuals and the team.
xperience in complaint management - with a proven track record in improving customer service standards
trong presentation skills, and knoweldge of Window Office tools like Word, Outlook, Excel, Powerpoint.
growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives.
xcellent interpersonal skills: strong empathy and listening skills, strong articulation and communciations skills
triving for excellent service to our members, clients and providers is part of your DNA.
ompetency to build a team and create an atmosphere of positive collaboration, innovation and creative solutioning among the team members
ction-orientated problem-solving attitude
xcellent organisation, planning and prioritisation skills
ble to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues
esults orientated - ability to cascade and explain goals, establish plans and manage work to achieve desired outcomes. Create meaningful business related metrics and track progress/results
ccountability - assume ownership for achieving personal results and collective team goals
OUR OFFER
challenging job in an international and growing enterprise.
dynamic, young and entrepreneurial company culture that values and stimulates initiative.
ttractive salary conditions with benefits package
**About The Cigna Group**
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®
Top 100 Most Loved Workplace®
Forbes Best-in-State Employer
Loss Adjusters (Melaka)
_This is a great time to join Sedgwick!_
_As we continue to grow, and invest in our people's learning & development, we are driving our hiring in Melaka, Malaysia._
_We are looking for people with drive and ambition to become our next generation Loss Adjusters or to build on their career as a Loss Adjuster._
_Here at Sedgwick, we have market leading programmes and market expertise to help individuals become the best in their chosen field, who are looking to take their career to the next level in a truly global organisation._
_We are looking to build and develop our expertise across all disciplines including Property, Casualty, Construction & Engineering etc._
_Depending on your interests and knowledge gained so far, we are also open to additional lines of business in helping you grow your career._
_We will invest, mentor, train and support you_ **_to fulfil your goals._** _We therefore want to create a sustainable long-term business by hiring in great talent, promoting, and developing our colleagues and growing the next generation of loss adjusters._
**_Ideally, we will be looking for:_**
+ _Fresh graduates with desire to learn and/or develop their career for the future - be inspired!_
+ _Customer focuses with strong customer relationship skills._
+ _To collaborate and build internal stakeholder relationships._
+ _Knowledge share and support one and other._
+ _Open to change, be inquisitive and help drive positive impact across our businesses._
Sedgwick is an Equal Opportunity Employer.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Sedgwick retains the discretion to add or to change the duties of the position at any time.
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®
Top 100 Most Loved Workplace®
Forbes Best-in-State Employer
Desktop Claims Handler (Property or Casualty claims)
The role of the Desktop Claims Handler is to ensure that the claim files assigned are managed and assessed in a professional manner. This will involve working with the policy holder, Insurers, Brokers, colleagues and other professionals to ensure the claim is valid.
+ Manage claims on desktop (without site survey) from start (first notice of loss) to end (finalisation)
+ Communicate with clients/claimants via phone and email to address queries, request further information and/or supporting documentation
+ Examine documentation and evidence to determine claim validity
+ Evaluate claims based on policy coverage and determine conditions have been met and exclusions have been applied
+ Maintain accurate, thorough and up-to-date claim file documentation throughout the claims process in the electronic claims management system
+ Ensure all data and supporting documents are entered into the claims management system
+ Manage an open portfolio of claims in a timely manner, ensuring claims are managed in line with client's SLAs
+ Identify and investigate potentially fraudulent claims with referral to Team Leader
+ Model ethical behaviour and execute job responsibilities in accordance with Sedgwick's core values, legal requirements, and industrial regulations/policies
Requirements:
+ A diploma or degree in any discipline
+ Professional certificates in insurance are desired
+ Minimal three (3) years of experience in end-to-end management of commercial claims for property and/or casualty space
+ Working knowledge of industry insurance policies/wordings and the claims life cycle
+ Possess strong command of spoken and written English
+ Good analytical and numeracy skills
+ Excellent interpersonal and critical thinking skills
+ Working knowledge of Microsoft Office 365 applications such as Word, Excel, PowerPoint, Outlook and Teams
+ Able to work independently and demonstrate personal initiative
+ Time management - ability to multi-task and adapt to priority change
+ Proficient in either the Mandarin and/or Cantonese language would be an added advantage
+ Demonstrates ability to work as a team to deliver our commitment to clients
+ Analytical, problem solving and organizational abilities
+ Meticulous and attention to details
+ Team Player
Sedgwick is an Equal Opportunity Employer.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Sedgwick retains the discretion to add or to change the duties of the position at any time.
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**