Claims Analyst (Medical)

Zurich 56 Company Ltd; Kuala Lumpur; On-site; MYR 35,000 - 60,000; Full time

Job summary

A leading insurance firm is seeking a Claims Analyst (Medical) in Kuala Lumpur to handle personal and commercial claims. Responsibilities include determining liability, analyzing coverage, and negotiating settlements while ensuring customer satisfaction and compliance with industry regulations. Required qualifications include a diploma or degree in Business, Insurance, or related fields, along with strong attention to detail and problem-solving skills. This role offers an opportunity to contribute to claims management and uphold the company's reputation.

Responsibilities

• Document claims file by accurately capturing and updating claims data/information.
• Determine liability by gathering and analyzing relevant facts.
• Analyse and determine policy coverage.
• Develop case strategy and evaluate cases for timely resolution.
• Establish timely reserves and perform ongoing review of claims.
• Assess damages and negotiate settlement of claims.
• Meet quality standards by following best practices.
• Ensure customer service by proactively communicating information.
• Ensure legal compliance by following laws and regulations.
• Refer claims to subrogation and fraud teams.
• Provide risk insight to business units or customers.
• Keep claims information confidential and protect the company's reputation.
• Participate in professional societies to understand industry trends.

Skills

Attention to detail

Problem-solving

Communication

Proficiency in Excel

Claims management systems

Education

Diploma or Degree in Business, Insurance, or related fields

Job description

Claims Analyst (Medical)

With moderate direction, handles single and multi-party personal or commercial line claims of low to moderate exposure and complexity within specific limits of authority by following established protocols to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

Job Accountabilities - Key Accountabilities

• Document claims file by accurately capturing and updating claims data/information.
• Determine liability by gathering and analyzing relevant facts.
• Analyse and determine policy coverage.
• Work to have a timely resolution to claims by developing case strategy, developing a case evaluation, escalating issues as appropriate.
• Establish timely reserves and perform ongoing review throughout the claims cycle within authority limits.
• Assess damages.
• Negotiate settlement of claim by establishing an appropriate negotiation strategy.
• Meet quality standards by following best practices.
• Ensure customer service by proactively communicating information, responding to inquiries, following customer protocols aligned to the organization's Claims Vendor Management strategy.
• Ensure legal compliance by following laws and regulations and internal control requirements.
• Refer claim to subrogation and fraud teams.
• Contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.
• Protect Zurich's reputation by keeping claims information confidential.
• Understand the current with industry trends and establish personal networks and participate in professional societies.

Job Qualifications

Required:

• Diploma or Degree in Business, Insurance, or related fields

Preferred:

• Attention to detail, problem-solving, communication, and proficiency in Excel and claims management systems.