Executive - Accident & Health

Pacific & Orient Insurance Co. Berhad; Kuala Lumpur; Presencial; MYR 60.000 - 120.000; Jornada completa

Descripción de la vacante

Pacific & Orient Insurance Co. Berhad invites professionals with robust claims experience to join our team in Malaysia. The role involves collaborating with business development on quotations, proposals, and scheme recommendations, while actively supporting claims system enhancements with the IT department.

You will manage Third Party Administrators and outsourcing providers, formalize SLAs, TATs and claims processes, and ensure strict adherence to SLAs with regular performance reviews.

Formación

• Experience in accident & health claims or underwriting.
• Strong understanding of claims processes and regulatory reporting.
• Excellent communication, analytical and problem-solving skills.

Responsabilidades

• Collaborate with business development teams on quotation, proposal discussions and scheme recommendations.
• Support claims system enhancements, customization and UAT with IT.
• Manage TPAs and outsourcing providers, formalize SLAs, TATs and claims processes.
• Ensure claims assessment and management comply with SLAs and monitor performance monthly/quarterly.
• Establish claims SOPs and provide training with Claims Department.
• Prepare and verify reports for associations and regulators on demand.
• Collaborate with reinsurers, reinsurance agents or brokers on claims-related risk support.
• Work with Actuarial and Pricing teams on product pricing and regulator submissions.
• Ensure all claims inquiries, settlements and complaints are managed within turnaround times.

Conocimientos

SLA management

Claims processing

Regulatory reporting

Stakeholder communication

Educación

Diploma/Degree in Insurance

Descripción del empleo

Collaborate with business development teams on quotation, proposal discussions, scheme recommendations, and claims-related structures.

Support claims system enhancements, customizations, and business requirement gathering with the IT department, including User Acceptance Testing (UAT).

Manage Third Party Administrators (TPAs) and other outsourcing service providers—from onboarding to performance monitoring—including formalizing Service Level Agreements (SLAs), turnaround times (TAT), and claims processes.

Ensure claims assessment and management by TPAs or service providers comply with SLAs, and monitor performance through regular monthly or quarterly reviews with the Claims Department.

Establish claims processes and Standard Operating Procedures (SOPs), provide training where necessary, and work closely with the Claims Department.

Prepare and verify reports for associations and regulators on a regular or ad-hoc basis.

Collaborate with reinsurers, reinsurance agents, or brokers on claims-related risk support.

Work with the Actuarial and Pricing teams on product or scheme pricing, and support submissions to regulators for approval or acknowledgment.

Ensure all claims enquiries, settlements, and complaints are managed within agreed turnaround timeframes.

Requirements:

Diploma or Degree in an Insurance related is an advantage.

Minimum 4 years of relevant experience in accident & health claims or underwriting.

Strong understanding of claims processes, SLA management, and regulatory reporting.

Excellent communication, analytical, and problem-solving skills.

Established in 1972, we are one of the leading general insurance companies in Malaysia with a wide network of branches. In line with our expansion plans, we seek highly motivated Malaysians to develop a career with us as: