Claims Management Associate / Analyst

Accenture PLC; Subang Jaya; Presencial; MYR 45.000 - 73.000; Jornada completa

Descripción de la vacante

Accenture PLC in Malaysia is seeking a Claims Handler to manage inbound/outbound calls from Insurance Agents and Customers, addressing inquiries on claims and policies. Responsibilities include registration and adjudication of claims, investigation, evaluation and settlement, and ensuring timely closure with proper data documentation.

Role requires strong communication, multitasking, and adherence to service levels.

Formación

• Able to prioritize and multitask effectively in a fast-paced environment.
• Strong communication, both verbal and written.
• Excellent relationship-building with internal and external parties.
• Proficient in desk management and telephone etiquette.
• Experience in customer service and claims processing is a plus.
• Working hours: Monday–Friday 8:30 AM–5:30 PM.

Responsabilidades

• Handle inbound and outbound calls from Insurance Agents and Customers to answer questions or attend requests regarding claims and policies.
• Register and adjudicate claims, including investigation, evaluation, negotiation and settlement.
• Collect, analyze data to determine claim acceptance or denial.
• Maintain accurate system data and documentation.
• Identify potential subrogation opportunities and fraud; refer as appropriate.
• Provide mentorship to less tenured examiners.
• Deputy/Backup Team Leader for governance, process and execution within the team.

Conocimientos

Prioritization & multitasking

Customer service

Communication skills

Relationship building

Time management

Handling difficult customers

Educación

Singapore College of Insurance - General Insurance and/or Health Insurance and Malaysian Insurance Institute qualifications

Descripción del empleo

Job Summary

The primary purpose of the job is to handle inbound and outbound calls from Insurance Agents and Customers to answer questions/ or attend to requests on but not limited to claim, policy inquiries, and handling complaints and irate customers etc. During call handling, he/she is required to check status of claims, review policy benefits and advise customers accordingly.

Apart from voice work, he/she will also be required to register and adjudicate claims which involve investigation, evaluation, negotiation and settlement. This is done by collecting and analyzing data according to policy application and/or contract provisions. Determine whether to accept or deny a claim based on all documentation received. Typical claims include liability and low complexity coverage issue disputes.

Job Descriptions

• Utilize advanced communication, comprehension and customer service skills to handle Customer/Agent requests and inquiries.

• Utilize acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records. May require additional contact with other parties i.e. employer, claimants, third parties such as medical providers, auto repair centers, etc. as deemed necessary

• Ensure proper follow up on cases to resolve outstanding issues and to ensure timely processing and closure of claim

• Provide timely service throughout the life of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, responding to incoming inquires according to company policies,following agreed internal and external processes, policies and proceduresto ensure quality and service standards are met. This includes all forms of communications to internal and external parties

• Maintain accurate system data and documentation by collecting, recording, analyzing, and summarizing information

• Ensure that reserves are accurately updated in a timely manner

• Identify subrogation opportunities and fraud potential and make appropriate referrals

• Provide mentorship to less tenured examiners

• Deputy/Backup Team Leader for all matters pertaining to operational governance, practice and execution in the team. Advocate of process & people management, operational excellence, metrics & management information, risk & compliance

#LI-GM

Job Requirement/Qualifications

• Certified in Singapore College of Insurance - General Insuranceand/or HealthInsurance and/or Professional Qualification in Malaysian Insurance Institute - Certificate of Insurance Practice/Diploma in Insurance/AMII/FMII

• Ability to prioritize and multitask effectively in a fast-paced environment

• Good relationship building skills (internal, external, and cross - cultural)

• Ability to communicate information clearly and concisely both verbally and in writing

• Requires proficiency in Desk Management, phone ‘etiquette’, time management and dealing with difficult customers

• Advance skills and experience in field of Customer Service (required) and/or Personal Accident Claims Processing (advantage)

• Communication skills and interpersonal skills will be an advantage

• Ability to document work in progress in accordance with applicable procedures will be an advantage

• Working Hours: Monday - Friday 8.30 AM - 5.30 PM