Claims Management Associate / Analyst

Accenture Southeast Asia; Subang Jaya; On-site; MYR 60,000 - 90,000; Full time

Job summary

Accenture Southeast Asia is seeking a claims processing specialist to handle inbound and outbound calls from Insurance Agents and Customers, answering questions on claims, policy inquiries, and handling complaints. You will adjudicate claims by collecting and analyzing data, determining acceptance or denial, and ensuring timely closure of cases.

Responsibilities include maintaining documentation, supporting subrogation opportunities, and mentoring junior examiners.

Qualifications

• Certified in Singapore College of Insurance - General Insurance and/or Health Insurance 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.

Responsibilities

• Handle inbound/outbound calls from Insurance Agents and Customers to answer questions or attend to requests on claims and policy inquiries.
• Register and adjudicate claims; collect and analyze data to determine claim acceptance or denial.
• Maintain accurate system data and documentation; ensure timely processing and closure of claims.

Skills

Communication skills

Time management

Customer service

Multitasking

Relationship building

Education

Insurance certifications

Diploma in Insurance

AMII/FMII

Job description

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 procedures to 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

Job Requirement/Qualifications

• Certified in Singapore College of Insurance - General Insurance and/or Health Insurance 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