Claim Assessor

MediExpress (Malaysia) Sdn Bhd; Subang Jaya; On-site; MYR 60,000 - 90,000; Full time

Job summary

MediExpress (Malaysia) Sdn Bhd. is seeking a Claim Assessor to review and adjudicate medical claims on-site in Subang Jaya. The role requires strong claims management, analytical and communication skills to ensure accurate adjudication and compliance with policy terms.

The ideal candidate will verify documentation, assess eligibility, and coordinate with providers and insurers, contributing to fraud detection and cost efficiency. Immediate start for a dedicated professional.

Qualifications

• Experience assessing medical or insurance claims.
• Strong analytical skills to interpret medical documentation and data trends.
• Effective communication with members, providers, insurers, and internal teams.

Responsibilities

• Review, validate, and assess medical claims per policy terms and guidelines.
• Verify supporting documentation, eligibility and coverage, and adjudicate within turnaround times.
• Communicate with healthcare providers, insurers, corporate clients, and members to clarify claim information and resolve discrepancies.
• Identify claim trends and contribute to process improvements to enhance service quality and cost efficiency.

Skills

Claims management

Analytical skills

Communication skills

Insurance claims knowledge

Attention to detail

multitasking in fast-paced env

Education

Diploma or degree in Insurance, Healthcare Management, Business

Tools

Office software

Claims processing systems

Job description

Company Description

MediExpress (Malaysia) Sdn Bhd, part of the Sumitomo Corporation Group, is a leading Third-Party Administrator specializing in employee medical benefits and claims for insurers and corporate clients. Based in Kuala Lumpur and founded in 1998, MediExpress serves a wide range of organizations, including publicly listed companies, mid-sized enterprises, and government bodies. The company combines technology and medical expertise, with a strong focus on preventive care, telemedicine, and e-pharmacy services to improve access and health outcomes. Through data analytics, MediExpress provides clients with critical insights into medical trends, disease patterns, and treatment costs, supporting better decision-making and cost containment. With over 300 employees operating around the clock, MediExpress is a trusted partner for timely, accessible healthcare administration.

Role Description

The Claim Assessor is a full-time, on-site role based in Subang Jaya. This role is responsible for reviewing, validating, and assessing medical claims in line with policy terms, internal guidelines, and regulatory requirements. The Claim Assessor will verify supporting documentation, check eligibility and coverage, and ensure accurate claim adjudication within agreed turnaround times. The role involves communicating with healthcare providers, insurers, corporate clients, and members to clarify claim information, resolve discrepancies, and provide updates on claim status. The Claim Assessor will also help identify claim trends, potential fraud or abuse, and contribute to process improvements to enhance service quality and cost efficiency.

Qualifications

• Candidates should possess strong Claims Management and Claims Handling skills, with experience assessing medical or insurance claims.
• Candidates should possess solid Analytical Skills to interpret medical documentation, policy terms, and data trends.
• Candidates should possess effective Communication skills for interacting with members, providers, insurers, and internal teams.
• Candidates should possess knowledge of Insurance Claims processes, policy coverage, and relevant guidelines or regulations.
• Diploma or degree in Insurance, Healthcare Management, Business, or a related field is beneficial.
• Attention to detail, integrity, and a high level of accuracy in documentation and data entry are required.
• Ability to work in a fast-paced environment, manage multiple cases, and meet service level timelines is expected.
• Proficiency in office software and claims processing systems; experience in a TPA or insurance environment is an advantage.