Associate, Group B40 Claims (GETB)

Great Eastern; Kuala Lumpur; On-site; MYR 30,000 - 40,000; Full time

Job summary

A leading insurance company in Kuala Lumpur seeks a Claims Assessor to review and process Hospitalization Benefit and Critical Illness claims. This entry-level role requires strong attention to detail and organizational skills, along with a formal degree in a relevant field. The candidate will work in a team, liaise with policyholders for claims resolution, and provide training to enhance assessment skills. This is a fantastic opportunity for those looking to grow a career in claims management.

Qualifications

• 0-2 years of experience in claims handling or customer service.
• Willingness to learn claims processes and industry regulations.
• Ability to work effectively within a team environment.

Responsibilities

• Review and assess claims documentation for accuracy and completeness.
• Liaise with policyholders and third parties for information.
• Maintain accurate records and follow up on outstanding claims documentation.
• Support senior team members in handling complex claims.

Skills

Attention to detail

Organizational skills

Communication skills

Problem-solving skills

Education

Formal degree in insurance, science, biomedical science, or a medical field

Tools

Microsoft Office

Job description

Overview

A Claims Assessor is responsible in assessing Hospitalization Benefit and Critical Illness claims, ensuring accuracy and adherence to company policies. This entry-level role provides an excellent opportunity for individuals looking to develop a career in claims management.

Responsibilities

• Review and assess Hospitalisation and Critical Illness claims documentation to ensure completeness and accuracy, determine the validity of claims and ensure they are processed in a timely manner.
• Liaise with policyholders and third parties to gather necessary information for claim resolution.
• Follow up on outstanding information and documentation for claims processing, maintain accurate records of claims activities and ensure proper documentation is filed.
• Support senior team members in handling complex claims or escalations.
• Adhere to company guidelines and regulatory requirements in all claim assessments.
• Provide feedback & guidance to the service provider / Third Party Administrator (TPA) to improve quality performance. Ensure TPA compliance with SLAs, including TAT, Quality and productivity targets.
• Prepare and monitor relevant reports to ensure smooth claims lifecycle.
• Prepare and conduct training for Claims team to close the gap in knowledge and improve quality assessment skills.

Qualifications

• Has a formal degree or higher qualification, preferably in insurance, science, biomedical science, or a medical field; additional medical certification is a plus.
• 0-2 years of experience in claims handling or customer service related.
• Willingness to learn and develop knowledge of claims processes and industry regulations.
• Strong attention to detail and organizational skills.
• Ability to work effectively within a team environment.

Key Competencies

Results‑driven with strong communication and interpersonal skills; ability to work under pressure, stay focused, and pay attention to detail; strong problem‑solving and analytical skills; strong communication skills and the ability to handle multiple tasks simultaneously.

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; strong strategic thinking and job‑specific knowledge.