Employee Benefits Claims Management, Analyst

AIA Malaysia; Kuala Lumpur; On-site; MYR 60,000 - 80,000; Full time

Job summary

A regional insurance provider in Kuala Lumpur is seeking a Claims Adjudicator to ensure accurate and timely claims processing. Key responsibilities include reviewing medical documentation, establishing proof of loss, and improving operational effectiveness. The ideal candidate has at least 5 years of experience in the insurance or medical industry, holds a Bachelor's degree, and possesses strong analytical and communication skills. Adaptability in a fast-paced environment is essential, along with a customer-focused mindset.

Qualifications

• Minimum of 5 years working experience in the insurance or medical industry.
• Able to work independently with minimal supervision.
• Good written and oral communication skills.

Responsibilities

• Ensure claims are adjudicated accurately and timely.
• Adjudicate medical claims following organizational guidelines.
• Establish proof of loss through assessment of medical documentation.

Skills

Customer focused

Analytical skills

Communication skills

Problem-solving skills

Multitasking

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Reporting tools

Job description

Overview

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone. It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030. And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business. Sound like you? Then read on.

About The Role

Ensure claims are adjudicated accurately and in a timely manner by establishing the validity of loss through assessment of medical documentation & assembling additional information as required.

Roles & Responsibilities

• Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company’s requirements and guidelines
• Adjudicate medical claims by following the organization guidelines & within the assigned authority limit.
• Establish covered medical insurance losses against benefits coverage and eligibility.
• Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required).
• Ensure confidentiality of all claims information, inclusive of claims guidelines and internal controls.
• To identify Process improvement ideas & initiatives leading to greater operations effectiveness and efficiency.
• Ensure claims are processed within the specified turnaround time
• To perform other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements.

Minimum Job Requirements

• Bachelor’s degree or equivalent, in any field of study or with relevant background.
• Minimum of 5 years working experience preferably in the insurance or medical industry.
• Candidate with medical insurance/nursing/medical science/hospital background will be added advantage.
• Able to work in fast paced environment, independent, customer focused, result oriented & disciplined.
• Adaptable and able to work on own with minimal supervision.
• Ability to multi-task, plan effectively and meet deadlines.
• Service oriented/customers focus with sense of urgency and practice prioritization and critical thinking in jobs.
• Demonstrate good written and oral communication skills.
• Good knowledge of using Microsoft Office and others software applications especially reporting tools.
• Able to adapt in the face of constant changes in the organization.
• Good analytical, innovative and good in problem solving skill, ability to exercise judgment and take initiative to make decision and resolve problem(s).
• Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
• Able to work on rotating shifts.
• Contract position available.