Claims Assessor (Shah Alam)

MiCare Sdn Bhd; Shah Alam; On-site; MYR 45,000 - 78,000; Full time

Job summary

MiCare Sdn Bhd is seeking a Medical Claims Assessor to join our Bukit Jelutong-based team in Malaysia. You will evaluate medical claims, review supporting documents, and ensure accurate, timely processing in line with policy terms and regulatory guidelines.

You will investigate discrepancies, respond to inquiries, and monitor for potential fraud while maintaining high-quality customer service. A Diploma or higher in Medical Science/Nursing/Pharmacy/Insurance is preferred, with fluency in English

Qualifications

• Diploma or higher in Medical Science, Nursing, Pharmacy, Insurance, or related field.
• Experience in medical claims or TPA/Insurance industry is an advantage.
• Must be computer literate with knowledge of Word, Excel, etc.
• Good command of English and Bahasa Malaysia, both speaking and writing.

Responsibilities

• Medical Claims Assessment & Processing: assesses and approves medical claims within required turnaround time per policies and regulations.
• Claims Investigation & Resolution: clarifies details with providers/clients and resolves discrepancies.
• Customer Inquiries & Communication: handles inquiries and informs clients of claim status.
• Documentation, Compliance & Fraud Monitoring: maintains records and monitors for irregularities, reports suspected fraud.
• Continuous Improvement & Additional Support: supports process improvements and ad hoc tasks.

Skills

Communication skills

Customer service

English proficiency

Bahasa Malaysia proficiency

Attention to detail

Education

Diploma

Advanced/Higher/Graduate Diploma

Bachelor’s Degree

Professional Certificate in Medical Science/Nursing/Pharmacy/Insurance

Tools

MS Word

MS Excel

Claims management system

Job description

MiCare, you join a team of caring, dynamic, courageous and dependable individuals who are working together to make healthcare more accessible in Asia.

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:

Medical Claims Assessment & Processing

Process, assess, and approve medical claims within the required turnaround time, ensuring compliance with company policies, procedures, insurance terms, and regulatory guidelines. Review medical reports, invoices, receipts, and other supporting documents for accuracy, completeness, and eligibility.

Claims Investigation & Resolution

Collaborate with healthcare providers, clients, agents, and internal departments to clarify claim details, resolve discrepancies, and obtain additional information or supporting documents needed for accurate claim assessment.

Customer Inquiries & Communication

Handle inquiries, feedback, and complaints related to medical claims promptly and professionally, while maintaining clear and consistent communication to keep clients informed of their claim status and progress.

Documentation, Compliance & Fraud Monitoring

Maintain accurate records of claims, supporting documents, and correspondence in the claims management system. Monitor for irregularities or suspicious claim patterns, investigate potential fraud, and report concerns to the appropriate supervisory personnel.

Continuous Improvement & Additional Support

Stay updated on medical billing codes, insurance policies, and healthcare regulations, while supporting process improvement initiatives, customer service enhancements, and other ad hoc tasks or projects assigned by supervisors or management.

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.

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.

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