CLAIMS EXECUTIVE / ASSISTANT

Compumed Services; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

A healthcare services provider in Kuala Lumpur is seeking an individual to manage insurance claims. Key responsibilities include adjudicating claims, preparing documents, ensuring timely submissions, and delivering excellent customer service. Candidates should possess relevant qualifications such as STPM/A Level/Diploma/Degree, and prior experience in medical/life insurance claims is preferred. Strong communication skills in both Bahasa Malaysia and English are required for this role.

Qualifications

• Experience in medical/life insurance claims, hospital services, and clinical services.
• Working experience in TPA, insurance or healthcare industry.
• Good understanding of medical insurance policies and its application is an added advantage.

Responsibilities

• Adjudicate claims for admission, outpatient, and major claims.
• Prepare complete documents for submission of claims to the insurance company.
• Ensure timely submission of claims and monitor closely on claims settlement timeline.
• Deliver quality customer service regarding medical/insurance claims.

Skills

Communication and interpersonal skills

Good spoken and written communication skills in Bahasa Malaysia & English

Computer literate

Knowledge of insurance/medical terminologies

High level of work commitment

Education

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

Job description

Responsibilities

• Adjudicate claims for admission, outpatient, and major claims.
• Compile supporting documents (including police report for MVA and assault claims) as attachments with each claim submission to relevant clients.
• Prepare claims bordereaux for submission to client/Finance Department together with the compiled supporting documents.
• Ensure timely submission of claims and monitor closely on claims settlement timeline.
• Prepare performance and productivity reports as required.
• Attend to inquiries regarding claims operating procedures at CompuMed.
• Deliver quality customer service and appropriate solutions regarding 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 regarding 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 regarding the company's operating procedures.
• Attend to inquiries and liaise with members regarding reimbursement procedures.
• Assist the call centre team and support new recruits in the Company.
• Subject to working night shifts and abiding to the duty roster prepared by the Management.
• Approve simple claims during and after office hours.
• Prepare Payment Notice, Guarantee Letter, and Decline Letter in daily course of duties.
• Perform relief tasks as and when required by the Management.
• Maintain a proper filing system.

Qualifications

• At least STPM / A Level / Pre-U / Diploma / Degree or equivalent in any field.
• Experience in medical/life insurance claims, hospital services, and clinical services.
• 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 its 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.