Executive - Claims Adjudicator (24/7 Cashless Administration)

Allianz; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

A leading insurance provider is seeking an Executive - Claims Adjudicator for their 24/7 Cashless Administration team in Kuala Lumpur. The ideal candidate will assess and process health claims efficiently while ensuring customer satisfaction. Applicants should have a diploma or degree in medical or health sciences with a minimum of 2–3 years' experience in the healthcare industry. Strong communication skills in English and Bahasa Malaysia are also required, along with the ability to work independently in a fast-paced environment.

Qualifications

• Minimum 2–3 years working experience in the healthcare industry.
• Able to work independently in a 24/7 fast-paced environment.
• Command of spoken and written English and Bahasa Malaysia.

Responsibilities

• Assess and process health/medical claims in line with policy guidelines.
• Manage day-to-day 24/7 operations for guarantee facilities.
• Respond to customer enquiries on claim reimbursement matters.

Skills

Good communication skills

Attention to detail

Result-oriented

Teamwork

Education

Diploma/Degree in medical or health science

Tools

AI tools like ChatGPT or Copilot

Job description

Executive - Claims Adjudicator (24/7 Cashless Administration)

This role is to process and review all medical/ health claims within the specified authority limit and ensure that payments are made within the turnaround time (TAT).

Responsibilities

• Assess and process all health/medical claims for reimbursement in line with policy guidelines within authority limits.
• Manage day‑to‑day 24/7 operations for guarantee facilities (hospital admission and discharge).
• Settle claims and ensure payments are processed within the agreed turnaround time and service standards.
• Support the Helpline team with enquiries pertaining to medical reimbursement.
• Respond to customers’ enquiries on claim reimbursement matters in a timely manner.
• Assume responsibilities of other team members as and when required.
• Participate in project initiatives to improve efficiency and productivity of the department.

Qualifications

• Diploma/Degree in any medical or health science related field of study.
• Minimum 2–3 years working experience in the healthcare industry or knowledge in medical/health claims.
• Good communication skills and command of spoken and written English and Bahasa Malaysia.
• Meticulous and attention to detail.
• Able to work independently in a 24/7 fast‑paced environment.
• Result‑oriented with a sense of urgency towards customer centricity.
• Demonstrates ability to work as a team to deliver Allianz’s enhanced customer experience journey.
• Familiarity with AI tools like ChatGPT or Copilot is an added advantage.
• Applicants must be willing to work in KL Sentral.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristic protected under applicable local laws and regulations.