17 Medical Appeals 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.

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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 .

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

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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.

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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

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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.

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AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

Join or sign in to find your next job

Join to apply for the Non- Medical Claims, Analyst role at AIA Malaysia

AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

Join to apply for the Non- Medical Claims, Analyst role at AIA Malaysia

Get AI-powered advice on this job and more exclusive features.

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

Process incontestable and contestable major claims in individual life policies

Position Objectives

• To ensure that the administration of Major Claims constantly meet the department goals that aligns and contributes to the Corporate Strategy.
  
  

Roles And Responsibilities

• Process and settle incontestable and contestable major claims (e.g. Critical Illness, Total and Permanent Disability, Dismemberment, Death claims) within TAT and in compliance with procedure and guidelines.
• Review pending cases every month and reduce pend ratio on the agreed goal set.
• OPAT savings – To monitor on the close file review and ensure timely provision reversal. Achieve less than 0.25% error rate from QC sampling size and 0% error recurrence.
• Meeting claims productivity and benchmark within authority limit, with high expectations and accuracy.
• Attend to enquiries / emails promptly and satisfactory. Other Functions
• Suspense management – suspense is cleared within 5 days.
• Perform other responsibilities, duties, projects, special assignments periodically assigned by supervisor in order to meet operational and/or other requirements.
  
  

Minimum Job Requirements

• Bachelor's degree holder or equivalent.
• Minimum 5 years working experience in insurance industry.
• Independent and self-starter.
• Customer service oriented, positive attitude and good interpersonal skills
• Spoken and written in both English and Malay language.
• Good Knowledge in claims assessments, FSA 2013 and technical skills.
  
  

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

Seniority level

• Seniority level Associate

Employment type

• Employment type Full-time

Job function

• Job function Finance and Sales
• Industries Insurance

Referrals increase your chances of interviewing at AIA Malaysia by 2x

Sign in to set job alerts for “Claims Analyst” roles.

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

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AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

Get AI-powered advice on this job and more exclusive features.

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

Process incontestable and contestable major claims in individual life policies

Position Objectives

• To ensure that the administration of Major Claims constantly meet the department goals that aligns and contributes to the Corporate Strategy.
  
  

Roles And Responsibilities

• Process and settle incontestable and contestable major claims (e.g. Critical Illness, Total and Permanent Disability, Dismemberment, Death claims) within TAT and in compliance with procedure and guidelines.
• Review pending cases every month and reduce pend ratio on the agreed goal set.
• OPAT savings – To monitor on the close file review and ensure timely provision reversal. Achieve less than 0.25% error rate from QC sampling size and 0% error recurrence.
• Meeting claims productivity and benchmark within authority limit, with high expectations and accuracy.
• Attend to enquiries / emails promptly and satisfactory. Other Functions
• Suspense management – suspense is cleared within 5 days.
• Perform other responsibilities, duties, projects, special assignments periodically assigned by supervisor in order to meet operational and/or other requirements.
  
  

Minimum Job Requirements

• Bachelor's degree holder or equivalent.
• Minimum 5 years working experience in insurance industry.
• Independent and self-starter.
• Customer service oriented, positive attitude and good interpersonal skills
• Spoken and written in both English and Malay language.
• Good Knowledge in claims assessments, FSA 2013 and technical skills.
  
  

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

Seniority level

• Seniority level Associate

Employment type

• Employment type Full-time

Job function

• Job function Finance and Sales
• Industries Insurance

Referrals increase your chances of interviewing at AIA Malaysia by 2x

Get notified about new Claims Analyst jobs in Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia .

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

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Claims Adjuster (Reinsurance/Property Claims/Casualty Claims) Reinsurance or Marine Claims Adjuster / Claims Executive

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

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

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Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 13 hours 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

AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Get AI-powered advice on this job and more exclusive features. At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

Process incontestable and contestable major claims in individual life policies

Position Objectives

To ensure that the administration of Major Claims constantly meet the department goals that aligns and contributes to the Corporate Strategy.

Roles And Responsibilities

Process and settle incontestable and contestable major claims (e.g. Critical Illness, Total and Permanent Disability, Dismemberment, Death claims) within TAT and in compliance with procedure and guidelines. Review pending cases every month and reduce pend ratio on the agreed goal set. OPAT savings – To monitor on the close file review and ensure timely provision reversal. Achieve less than 0.25% error rate from QC sampling size and 0% error recurrence. Meeting claims productivity and benchmark within authority limit, with high expectations and accuracy. Attend to enquiries / emails promptly and satisfactory. Other Functions Suspense management – suspense is cleared within 5 days. Perform other responsibilities, duties, projects, special assignments periodically assigned by supervisor in order to meet operational and/or other requirements.

Minimum Job Requirements

Bachelor's degree holder or equivalent. Minimum 5 years working experience in insurance industry. Independent and self-starter. Customer service oriented, positive attitude and good interpersonal skills Spoken and written in both English and Malay language. Good Knowledge in claims assessments, FSA 2013 and technical skills.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date. Seniority level

Seniority level Associate Employment type

Employment type Full-time Job function

Job function Finance and Sales Industries Insurance Referrals increase your chances of interviewing at AIA Malaysia by 2x Get notified about new Claims Analyst jobs in

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia . Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 day ago Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago Claims Adjuster (Reinsurance/Property Claims/Casualty Claims)

Reinsurance or Marine Claims Adjuster / Claims Executive

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 day ago Unit Head, Fast Track & Co/RI Claims(Fire/Eng/Misc/Marine)

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 6 days ago Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago Financial Accountant (Claim and Reservation)

Assistant Manager, Claims, Property & Casualty

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 6 days ago Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago Assistant Manager, Underwriting & Risk Management Analyst (General Insurance)

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 month ago Associate, Company Secretary (Secretarial)

Federal Territory of Kuala Lumpur, Malaysia 1 week ago Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 13 hours 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

AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Join or sign in to find your next job

Join to apply for the

Non- Medical Claims, Analyst

role at

AIA Malaysia AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Join to apply for the

Non- Medical Claims, Analyst

role at

AIA Malaysia Get AI-powered advice on this job and more exclusive features. At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

Process incontestable and contestable major claims in individual life policies

Position Objectives

To ensure that the administration of Major Claims constantly meet the department goals that aligns and contributes to the Corporate Strategy.

Roles And Responsibilities

Process and settle incontestable and contestable major claims (e.g. Critical Illness, Total and Permanent Disability, Dismemberment, Death claims) within TAT and in compliance with procedure and guidelines. Review pending cases every month and reduce pend ratio on the agreed goal set. OPAT savings – To monitor on the close file review and ensure timely provision reversal. Achieve less than 0.25% error rate from QC sampling size and 0% error recurrence. Meeting claims productivity and benchmark within authority limit, with high expectations and accuracy. Attend to enquiries / emails promptly and satisfactory. Other Functions Suspense management – suspense is cleared within 5 days. Perform other responsibilities, duties, projects, special assignments periodically assigned by supervisor in order to meet operational and/or other requirements.

Minimum Job Requirements

Bachelor's degree holder or equivalent. Minimum 5 years working experience in insurance industry. Independent and self-starter. Customer service oriented, positive attitude and good interpersonal skills Spoken and written in both English and Malay language. Good Knowledge in claims assessments, FSA 2013 and technical skills.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date. Seniority level

Seniority level Associate Employment type

Employment type Full-time Job function

Job function Finance and Sales Industries Insurance Referrals increase your chances of interviewing at AIA Malaysia by 2x Sign in to set job alerts for “Claims Analyst” roles.

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Non- Medical Claims, Specialist page is loaded Non- Medical Claims, Specialist Apply locations Kuala Lumpur, MY-AIA Malaysia time type Full time posted on Posted 4 Days Ago job requisition id JR-57148

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone. It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030. And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business. Sound like you? Then read on. About the Role Process incontestable and contestable major claims in individual life policies

Position Objectives: To ensure that the administration of Major Claims constantly meet the department goals that aligns and contributes to the Corporate Strategy. Roles and Responsibilities: Process and settle incontestable and contestable major claims (e.g. Critical Illness, Total and Permanent Disability, Dismemberment, Death claims) within TAT and in compliance with procedure and guidelines. · Review pending cases every month and reduce pend ratio on the agreed goal set. OPAT savings – To monitor on the close file review and ensure timely provision reversal. Achieve less than 0.25% error rate from QC sampling size and 0% error recurrence. Meeting claims productivity and benchmark within authority limit, with high expectations and accuracy. Attend to enquiries / emails promptly and satisfactory. Other Functions · Suspense management – suspense is cleared within 5 days. Perform other responsibilities, duties, projects, special assignments periodically assigned by supervisor in order to meet operational and/or other requirements. Minimum Job Requirements: Bachelor's degree holder or equivalent. Minimum 5 years working experience in insurance industry. Independent and self-starter. Customer service oriented, positive attitude and good interpersonal skills Spoken and written in both English and Malay language. Good Knowledge in claims assessments, FSA 2013 and technical skills. Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives. You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date. Similar Jobs (4)

Non-Medical Claims (PA), Analyst locations Kuala Lumpur, MY-AIA Malaysia time type Full time posted on Posted 30+ Days Ago Non-Medical Claims, Analyst locations Kuala Lumpur, MY-AIA Malaysia time type Full time posted on Posted 30+ Days Ago Non-Medical Claims, Consultant locations Kuala Lumpur, MY-AIA Malaysia time type Full time posted on Posted 14 Days Ago At AIA, we don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us. We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives, build healthier societies and cultivate healthier environments that better everyone. If you believe in better, we’d love to hear from you.

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At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

Process authorized inpatient & outpatient claims transactions within the required benchmarks.

• Process all Inpatient, Outpatient claims and pre-approval requests received as per stipulated requirements
• Ensure meeting individual quality, turn around time and productivity benchmark
• Review/approve cases that exceeds subordinates’ authority
• Respond to email enquiries from internal and external parties
• Perform outbound call to customers when required
• Training of new joiners on claims processing rules and products knowledge including Review and Feedback for On-The-Job training cases
• Providing training in System Navigation and Processing Steps, towards certification with Claims Approval Authority, as stipulated in the Claims Approval Authority guidelines.
• Conduct regular claims review in claims performance to ensure claims principles/authorities are adhered to. Review claims decision making process to identify areas of claims risk management concerns for further improvements.
• Organize and implement team engagement activities to foster closer team spirit and create work life balance environment.
• Performs other responsibilities and duties periodically assigned by immediate manager in order to meet business requirements
  
  

Qualifications

• Educational background in Biomedical, Biotechnology, Nursing, Medicine, Chemistry or related fields
• Candidate MUST able to speak Mandarin. Ability to read and write Chinese would be an added advantage.
• Possess a minimum of 2 years experience in Medical/Life Claims processing experience
• Comfortable working onsite in Cyberjaya 4 days a week and 1 day work from home
  
  

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

Seniority level

• Seniority level Mid-Senior level

Employment type

• Employment type Full-time

Job function

• Job function Health Care Provider
• Industries Insurance

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