Claims Assessor (Shah Alam)

MiCARE; Selangor; On-site; MYR 100,000 - 150,000; Full time

Job summary

A leading managed care organization in Malaysia is seeking a detail-oriented Medical Claims Assessor. The role entails efficient processing and assessment of medical claims, handling inquiries, and ensuring compliance with regulations. Candidates should possess a relevant Diploma or Degree, strong communication skills, and the ability to work independently in a fast-paced environment.

Benefits

Flexible working hours

Professional development opportunities

Qualifications

• Minimum qualifications include a Diploma or higher in relevant fields.
• Good command in English & Bahasa Malaysia, both spoken and written.
• Technical knowledge of medical claims will be an advantage.

Responsibilities

• Process and assess medical claims efficiently with adherence to policies.
• Investigate potential fraudulent claims and report discrepancies.
• Maintain accurate records of claims and ensure timely documentation.

Skills

Customer Service

Attention to Detail

Communication

Education

Diploma or Bachelor's Degree in Medical Science/Nursing/Pharmacy/Insurance

Tools

Microsoft Word

Microsoft Excel

Job description

Job Purpose:
The Medical Claims Assessor is responsible for the accurate and timely assessment of medical claims, ensuring compliance with policy terms and conditions. This role requires the ability to evaluate claims documentation, handle inquiries, investigate potential fraud, and provide high-quality customer service while adhering to company protocols and deadlines.

Key Responsibilities:

Claims Assessment:

• Process and assess medical claims efficiently within the specified turnaround time, ensuring compliance with company policies, procedures, and insurance terms.
• Review and verify claims documentation for accuracy and completeness, including medical reports, invoices, and receipts.
• Collaborate with healthcare providers, clients, and internal teams to resolve any discrepancies in claims submissions.

Inquiries and Correspondence:

• Respond to inquiries related to medical claims, including feedback and complaints, promptly and professionally.
• Maintain clear and consistent communication with clients, ensuring they are kept informed of their claims' progress.

Document Management:

• Ensure that all requests for supporting documents and additional information required for claim assessments are followed up on and obtained in a timely manner.
• Maintain accurate records of claims, supporting documents, and communications in the claims management system.

Fraud Detection and Reporting:

• Investigate potential fraudulent claims, including irregularities in documentation or unusual patterns.
• Report any suspicious activity or claims irregularities to the appropriate supervisory personnel for further investigation.

Compliance and Accuracy:

• Ensure that claims assessments adhere to internal and external regulatory guidelines.
• Keep updated with the latest medical billing codes, insurance policies, and healthcare regulations.

Additional Duties:

• Perform ad hoc tasks and projects as assigned by supervisors or managers.
• Assist with process improvement initiatives related to claims management and customer service.
• Candidate must possess at least a Diploma, Advanced/Higher/Graduate Diploma, Bachelor’s Degree, Professional Certificate in Medical Science/Nursing/Pharmacy/Insurance or any related field.
• Candidate with technical knowledge of medical claims or relevant working experience in Third Party Administration (TPA) / Insurance Industry will be an added advantage.
• Good command in English & Bahasa Malaysia, both speaking and writing.
• Able to work in fast paced environment, independent, customer focused and proactive working attitude with strong sense of responsibility.
• Must be computer literate with knowledge of office applications such as Word, Excel, etc.
• Flexible and willing to work extra hours as and when required.
• Possess own transport.

This position will be based in Bukit Jelutong, Shah Alam

Candidates are required to apply online and only shortlisted for interview will be contacted.

Unlock job insights

Salary match Number of applicants Skills match

Your application will include the following questions:

How many years' experience do you have as a claims assessor? Which of the following types of qualifications do you have? Which of the following statements best describes your right to work in Malaysia? Do you possess or have access to your own transportation? How much notice are you required to give your current employer? What's your expected monthly basic salary? Are you willing to undergo a pre-employment background check? How many years' experience do you have as a Medical Claims Executive?

MiCare Healthtech Holdings Pte Ltd (“MiCare”) is a regional, leading managed care organization headquartered in Singapore that administers, processes, and manages medical claims on behalf of insurance companies and self-insured corporate clients. The company serves more than 13 million members in Malaysia, Thailand, and the Philippines through its strong relationships with over 45 insurers and 6,500 corporate clients in Southeast Asia. MiCare has an extensive provider network of over 5,000 hospitals, clinics, and pharmacies. MiCare is a joint venture between Zuellig Group, Mitsui & Co (Asia Pacific) (“Mitsui”), and the International Finance Corporation (“IFC”), with Mitsui and IFC investing US$60 million into MiCare in 2021.

Zuellig Group is one of Asia's largest healthcare services groups providing distribution, digital and commercial solutions. The company has grown to become a US$13 billion business covering 13 markets with over 12,000 employees.

Mitsui is a Japanese conglomerate that focuses its business model on growth through trading, business management, and project development. Listed on the Tokyo Stock Exchange with a market capitalization of over US$40 billion, Mitsui brings a regional network of healthcare assets, including strong relationships with providers as well as extensive experience in digital transformation. Of note, Mitsui is the single largest shareholder of IHH Healthcare Bhd, the largest private hospitals group in Pan-Asia, operating 80 hospitals in 10 countries under a portfolio of brands such as Acibadem, Pantai, Fortis and Gleneagles.

IFC, a member of the World Bank Group, is the largest development institution focused on the private sector in emerging markets. IFC has an active portfolio of $2 billion in health care companies in emerging markets. Through these investments, IFC helps private providers meet the soaring demand for health care and supports governments in their goal of reaching Universal Health Coverage by 2030.

MiCare Healthtech Holdings Pte Ltd (“MiCare”) is a regional, leading managed care organization headquartered in Singapore that administers, processes, and manages medical claims on behalf of insurance companies and self-insured corporate clients. The company serves more than 13 million members in Malaysia, Thailand, and the Philippines through its strong relationships with over 45 insurers and 6,500 corporate clients in Southeast Asia. MiCare has an extensive provider network of over 5,000 hospitals, clinics, and pharmacies. MiCare is a joint venture between Zuellig Group, Mitsui & Co (Asia Pacific) (“Mitsui”), and the International Finance Corporation (“IFC”), with Mitsui and IFC investing US$60 million into MiCare in 2021.

Zuellig Group is one of Asia's largest healthcare services groups providing distribution, digital and commercial solutions. The company has grown to become a US$13 billion business covering 13 markets with over 12,000 employees.

Mitsui is a Japanese conglomerate that focuses its business model on growth through trading, business management, and project development. Listed on the Tokyo Stock Exchange with a market capitalization of over US$40 billion, Mitsui brings a regional network of healthcare assets, including strong relationships with providers as well as extensive experience in digital transformation. Of note, Mitsui is the single largest shareholder of IHH Healthcare Bhd, the largest private hospitals group in Pan-Asia, operating 80 hospitals in 10 countries under a portfolio of brands such as Acibadem, Pantai, Fortis and Gleneagles.

IFC, a member of the World Bank Group, is the largest development institution focused on the private sector in emerging markets. IFC has an active portfolio of $2 billion in health care companies in emerging markets. Through these investments, IFC helps private providers meet the soaring demand for health care and supports governments in their goal of reaching Universal Health Coverage by 2030.

To help fast track investigation, please include here any other relevant details that prompted you to report this job ad as fraudulent / misleading / discriminatory.

Researching careers? Find all the information and tips you need on career advice.