Assistant Manager/Senior Executive, Claims

Hong Leong Assurance; Selangor; On-site; MYR 50,000 - 80,000; Full time

Job summary

A leading insurance company is seeking a Claim Assessment Specialist to process and review claims while ensuring compliance with regulations. The ideal candidate will possess a Bachelor's Degree in a relevant field and have a minimum of 3 years’ experience in the life insurance industry, including at least 2 years in a supervisory role. Strong interpersonal and customer service skills are essential, with an emphasis on effective communication and problem-solving in a fast-paced environment.

Qualifications

• Minimum 3 years of claim assessment skills in life insurance.
• Experience in a supervisory role for at least 2 years.
• Good understanding of Insurance Guidelines and Insurance Act.

Responsibilities

• Process and review claim cases within specified authority limit.
• Attend to claim enquiries and complaints from various parties.
• Monitor and ensure productivity and Service Level Agreement are met.
• Assist in preparing monthly reports and maintaining documentation.
• Participate in process improvement project initiatives.

Skills

Claim assessment skills

Interpersonal skills

Customer service skills

Ability to work under pressure

Medical knowledge

Education

Bachelor's Degree in Medical Science, Nursing, Biology or equivalent

Job description

Process and review claim cases within specified authority limit and TAT.

Attend to claim enquiries, appeals and complaints from internal and external parties (e.g. OFS, BNM or Third Party Administrator) and constantly follow up for pending cases.

Ensure that issues highlighted are resolved effectively and promptly through the established departmental processes and procedures.

Perform investigation on potential fraudulent claims or suspicious cases.

Monitor and ensure that productivity and Service Level Agreement are met within the team.

Assist in preparing monthly reports and maintain documentation of processes.

Participate in process improvement project initiatives to improve efficiency and productivity of the department.

Backup team members and assume the responsibilities as and when required.

Ensure compliance to policies, guidelines and regulations.

Perform other duties as delegated by the Management.

Requirements

Candidate must possess at least a Bachelor's Degree in Medical Science, Nursing, Biology or equivalent.

Minimum 3 years of claim assessment skills in life insurance industry; Assistant Manager level at least 5 years experience with at least 2 years of supervisory experience.

Good knowledge of general medical knowledge, understanding and application of Insurance Guidelines and Insurance Act.

Demonstrate good interpersonal skills, customer service skills, and ability to work under pressure.