CLAIMS EXECUTIVE / ASSISTANT

Compumed Services; Kuala Lumpur; On-site; MYR 39,000 - 56,000; Full time

Job summary

Compumed Services in Kuala Lumpur is seeking a claims adjudication professional to handle admission, outpatient and major claims with a focus on timely submissions and accurate documentation. You will compile attachments, prepare borderaux, and ensure smooth claims processing while providing quality customer service to members and insurers.

The role requires knowledge of medical/insurance terminologies, relevant qualifications, and strong communication skills in Bahasa Malaysia and English;

Qualifications

• At least STPM/ "A" Level/ Pre-U / Diploma / Degree or equivalent in any field.
• Those with medical/life insurance claims, hospital services, and clinical services experience
• Knowledge of insurance/medical terminologies and insurance policy.
• Working experience in healthcare, insurance or similar capacity.
• High level of work commitment and strong sense of responsibility
• Good understanding of medical insurance policies and it application is an added advantage
• Good spoken and written communication skills in Bahasa Malaysia & English
• Communication and interpersonal skills.
• Computer Literate
• Working experience in TPA, insurance or healthcare industry

Responsibilities

• To adjudicate claims for admission, outpatient and major claims.
• Compile supporting documents as attachment (including police report for MVA and assault claims) with each claim submission to relevant clients
• Prepare claims borderaux for submission to client/ Finance Department together with the complied supporting documents
• Ensure timely submission of claims and monitor closely on claims settlement timeline.
• Prepare performance report & productivity report as required
• Attend to inquiries with regards to claims operating procedures at CompuMed
• Deliver quality customer service and appropriate solutions with regards to medical/insurance claims and clinical services issues.
• Provide a polite, professional and accurate response in accordance with the agreed service standards.
• Liaise with hospital personnel with regards to the management of a member during pre-hospitalization, hospitalization and post hospitalization.
• Prepare complete documents for submission of claims to the insurance company.
• Update the status of members during hospitalization.
• Attend to inquiries from insurance companies and service providers with regards the Company’s operating procedures.
• Attend to inquiries and liaise with members regarding reimbursement procedures.
• Assist the Call Centre Team and support to the new recruits in the Company.
• Subject to working night shifts and abiding to the duty roster prepared by the Management.
• Approval of simple claims during and after office hours.
• Prepare Payment Notice, GL & Decline Letter in daily course of duties.
• Perform relief task as and when required by the Management.
• Maintain a proper filing system.

Skills

Claims processing

Customer service

Medical terminology

Documentation

Education

STPM / A-Level / Pre-U / Diploma / Degree

Job description

Jora Malaysia will close on 9th September 2026. Thank you for being with us, we are cheering you on as you continue your career journey.

JOB SCOPE (Major Responsibilities of this job)

To adjudicate claims for admission, outpatient and major claims.

Compile supporting documents as attachment (including police report for MVA and assault claims) with each claim submission to relevant clients

Prepare claims borderaux for submission to client/ Finance Department together with the complied supporting documents

Ensure timely submission of claims and monitor closely on claims settlement timeline.

Prepare performance report & productivity report as required

Attend to inquiries with regards to claims operating procedures at CompuMed

Deliver quality customer service and appropriate solutions with regards to medical/insurance claims and clinical services issues.

Provide a polite, professional and accurate response in accordance with the agreed service standards.

Liaise with hospital personnel with regards to the management of a member during pre-hospitalization, hospitalization and post hospitalization.

Prepare complete documents for submission of claims to the insurance company.

Update the status of members during hospitalization.

Attend to inquiries from insurance companies and service providers with regards the Company’s operating procedures.

Attend to inquiries and liaise with members regarding reimbursement procedures.

Assist the Call Centre Team and support to the new recruits in the Company.

Subject to working night shifts and abiding to the duty roster prepared by the Management.

Approval of simple claims during and after office hours.

Prepare Payment Notice, GL & Decline Letter in daily course of duties.

Perform relief task as and when required by the Management.

Maintain a proper filing system.

JOB SPECIFICATION

At least STPM/ "A" Level/ Pre-U /Diploma/Degree or equivalent in any field.

Those with medical/life insurance claims, hospital services, and clinical services experience

Knowledge of insurance/medical terminologies and insurance policy.

Working experience in healthcare, insurance or similar capacity.

High level of work commitment and strong sense of responsibility

Good understanding of medical insurance policies and it application is an added advantage

Good spoken and written communication skills in Bahasa Malaysia & English

Those with medical/life insurance claims, hospital services, and clinical services experience

Knowledge of insurance/medical terminologies and insurance policy.

Communication and interpersonal skills.

Computer Literate

Working experience in TPA, insurance or healthcare industry