Claims Specialist

HealthMetrics; Subang Jaya; On-site; MYR 45,000 - 89,000; Full time

Job summary

HealthMetrics is seeking a Claims Specialist to process inpatient and outpatient claims, ensuring accuracy and fast turnaround. The role involves handling guarantee letters, investigating claims, and communicating with members, hospitals, and corporates.

Candidates should have a medical-related degree, experience in claims processing, and a proactive, tech-minded approach. The position may require shifts, weekends, and holidays as needed.

Qualifications

• Diploma/Degree holders in Medicine, Nursing, Biomedicine, Bioscience, Healthcare Management or related fields.
• Experience in claims handling and/or processing is preferred; inpatient claims experience is an advantage.
• Interest in AI, technology and new ways of working to improve daily processes.
• Self-driven and willing to learn; able to pick up new tools, systems and processes independently.
• Proactive and improvement-minded with an eye for inefficiencies and smarter workflows.
• Strong problem-solving skills and attention to detail; able to review information and make sound decisions.
• Customer and results-oriented with good communication and timely delivery.
• Able to work shifts, odd hours, weekends and public holidays when required.

Responsibilities

• Review, research, investigate, and process claims with expertise or general support.
• Process Guarantee Letter applications (inpatient or outpatient), top-ups and final letters.
• Handle inquiries for guarantee letters using patient reports and test results.
• Respond to claims queries from members, corporates and hospitals via phone and email.

Skills

Claims processing

Customer service

Attention to detail

Education

Diploma/Degree in Medicine, Nursing, Biomedicine, Bioscience, Healthcare Management

Tools

Medical claims software

Hospital information systems

Job description

We're Hiring: Claims Specialist (Multiple Headcounts | Inpatient Claims Experience Preferred)

Contract: 1-Year Renewable Contract (Subject to Performance & Business Needs)

Summary

The role of a Claims Specialist is to process all the submission claims received from members, corporates or hospital within the turnaround time, to clarify information and to provide solutions and/or alternatives to members, corporates and hospital. Ensure to process the claims and GL related accurately and correctly within the targeted turnaround time, ensuring good service, correct information and good understanding is provided to the members, hospitals and corporate. Handle all document related with the claims and manage the filing system systematically.

Job Responsibilities:

• Provide expertise or general support by reviewing, researching, investigating, and processing claims.
• Process Guarantee Letter (inpatient or outpatient) application, top-up and final Guarantee Letter.
• Process requests and investigative queries for guarantee letter(s) based on patient medical report, laboratory test results, etc.
• Handle queries of claims from members, corporates and hospitals via phone and email.
• Handle incoming cases/calls for hospital admission and discharge processes for patients in local.
• Resolve any technical or contentious claims within the boundaries of medical knowledge and policy held.
• Prepare any and all necessary documentation(s) for customers' best experience.
• Paperwork and administrative work including filling and etc.
• Any ad hoc task if required.

Job Requirements:

• Diploma/Degree holders, preferably in Medicine, Nursing, Biomedicine, Bioscience, Healthcare Management or related fields.
• Experience in claims handling and/or processing is preferred, with inpatient claims experience being an advantage.
• Curious and interested in AI, technology and new ways of working, with a willingness to explore how these can improve daily work and processes.
• Self-driven and willing to learn, with the ability to pick up new tools, systems and processes independently.
• Proactive and improvement-minded, with an eye for identifying inefficiencies, repetitive tasks and opportunities to work smarter.
• Strong problem-solving skills and attention to detail, with the ability to review information carefully and make sound decisions.
• Customer and results-oriented, with the ability to understand customer needs, communicate clearly, resolve issues effectively and deliver work within the required turnaround time.
• Adaptable and able to work independently with minimal supervision while working well with others.
• Able to converse, read and write English and Bahasa Malaysia fluently.
• Able to work shifts, odd hours, weekends and public holidays when required.

Why Join Us?

Gain exposure to healthcare administration and medical claims management

Work closely with hospitals, healthcare providers, and corporate clients

Be part of a team exploring how AI can improve healthcare claims operations

Build valuable healthcare industry knowledge and operational expertise

Opportunities for learning, growth, and career development

Dynamic and collaborative working environment

If you're passionate about healthcare, enjoy problem-solving, and want to make a meaningful difference in people's healthcare journeys.