Assistant Manager, Group B40 Claims (GETB)

Great Eastern; Kuala Lumpur; On-site; MYR 60,000 - 80,000; Full time

Job summary

A leading insurance provider is seeking an Assistant Manager for Third Party Administrator Claims Management in Kuala Lumpur. The role involves ensuring compliance with SLAs, leading a team of claims assessors, and optimizing claims processing performance. Candidates should have a formal degree, a minimum of 3 years' experience in claims handling, and strong communication skills. Proficiency in Microsoft Office is essential. This position promotes a collaborative team culture and supports operational efficiency.

Qualifications

• At least 3 years of experience in claims handling.
• Demonstrated ability to lead or mentor a team.
• Strong understanding of claims processes.

Responsibilities

• Ensure TPA's compliance with SLAs and targets.
• Provide expert advice for complex claims to TPA.
• Prepare management and performance reports.

Skills

Leadership

Claims handling

Team dynamics management

Conflict resolution

Communication

Education

Degree in science, biomedical science, or a medical field

Tools

Microsoft Office

Job description

Overview

An Assistant Manager for Third Party Administrator (TPA) Claims Management ensures efficient and compliant management of TPA claims processing, optimizing performance against SLAs, improving quality assurance, and driving continuous process enhancements. This role involves managing performance of TPA in Claims related matters, providing guidance to TPA, and participate in TPA service monitoring.

Key Responsibilities

• Ensure TPA's compliance with SLAs, including TAT, Quality and productivity targets.
• Ensure seamless coordination between internal teams and the TPA for effective claims handling.
• Act as liaison person to deal with TPA for continuous improvement on current process, track key performance metrics and identify areas for improvement. Provide on-the-job training and development to TPAs, ensuring TPA's competency and skill growth.
• Provide expert advice and resolution for complex or contentious issues including investigation on suspicious claims and complex claims to TPA.
• Promote a positive team culture, encouraging high morale and motivation. Support additional tasks as required to drive operational efficiency and service excellence.
• Collaborate with management to ensure the claims team meets departmental goals and targets. Carry out all management support tasks assigned in a timely and accurate manner within the deadline set by department stakeholders and management.
• Prepare reports including management reports, periodic reports of team performance, productivity reports, documents and reports required for audit purposes.
• Ensure claims assessment accordingly follows industry standards, compliance with policy and regulations.

Qualifications

• Has a formal degree or higher qualification, preferably in science, biomedical science, or a medical field; additional medical certification is a plus.
• Has at least 3 years of experience in claims handling, with a demonstrated ability to lead or mentor a team.
• Has the ability to lead and support a small team of claims assessors.
• Has strong understanding of claims processes and the ability to apply them to various scenarios.
• Has excellent communication and coaching skills to develop the team.
• Has the ability to handle conflicts and resolve issues effectively.

Key Competencies

• Strong organizational and time‑management skills.
• Excellent interpersonal skills and the ability to manage team dynamics effectively.

Key Knowledge

• Proficient in Microsoft Office (Word, PowerPoint, Excel) and IT literate.
• Knowledge of Takaful/Insurance regulations and legal requirements, claims processing, and data analysis.