Executive, Healthcare (Including Night Shift & Weekends)

Prudential Group; Kuala Lumpur; On-site; MYR 30,000 - 45,000; Full time

Job summary

A leading insurance company in Kuala Lumpur is seeking a Claims Administrator responsible for ensuring efficiency in claims processing. Role entails assessing and approving claims within defined timeframes, handling customer inquiries, and ensuring compliance with regulations. Candidates with a relevant degree or fresh graduates are encouraged to apply. The environment is dynamic, requiring excellent communication and problem-solving skills, coupled with a knack for attention to detail.

Qualifications

• Fresh graduates or candidates with at least 1 year experience preferred.
• Life Insurance background is an advantage.

Responsibilities

• Provide efficient support to operational processes.
• Assess and provide justifiable claims according to policy.
• Approve claims within benchmark turnaround time.
• Handle incoming inquiries via multiple channels.

Skills

Claims Assessment

Customer Service

Problem-solving

Attention to Detail

Education

Degree in Biomedical Science, Allied Health, Biology, Mathematics, Economics, Statistics, Business Administration

Job description

The incumbent is responsible to provide efficient and effective support to the Company goals by meeting and exceeding their expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure claims are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers (on shift nature)

Position Summary

• Claims Assessment
• Claims Recommendation
• Claims Approval within authority limit

PRINCIPAL DUTIES & RESPONSIBILITIES

• Adhering to our claim workflow in relation to hospitalization claims procedure.
• Assess and provide justifiable claims according to policy terms and conditions to our valued policy holders.
• Approving claims within the department benchmark/turnaround time and authority limit
• Recommend for claim approval/repudiation
• Ensuring customers enquiry from all source of referrals are promptly attended to and resolves via appropriate communication mode.
• To ensure and monitor claims processing benchmark and turnaround time
• To correspondences on and day to day operation functions of the department and coordinates with other departments
• To handle incoming enquiries from internal or external parties via emails, phone calls and portal.
• Updating and submission of reports as required by management within the agreed service standards.
• Liaise with Prudential Malaysia’s IT division to troubleshoot issues / cases encountered in the day to day operations.
• Continuously review and update/document the administrative rules and processes effective and efficient operation of the section.
• Continuously attend / involve with training for personal and career development.
• Undertake projects / other work and duties allocated by Management, as and when required
• Ensuring that Financial Services Act (FSA), Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.

JOB SPECIFICATION

• Degree in Biomedical Science, Allied Health or Biology, Mathematics, Economics, Statistics, Business Administration, and etc.
• Experience: Preferably experience in HealthCare, financial institutions, i.e. Banks, Insurance for at least 1 Year. Fresh graduate can be considered.
• Life Insurance background, preferably in Health, Accidental & or Life Claims

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