Health Claims Operations Lead (Digitalisation & Analytics)

FWD Malaysia Holdings Sdn Bhd; Kuala Lumpur; On-site; MYR 180,000 - 300,000; Full time

Job summary

FWD Malaysia Holdings Sdn Bhd is seeking a leader to head the end-to-end Health Claims operations, covering hospitalization, surgical, outpatient, medical reimbursement, and group medical claims.

You will drive fair, consistent claims assessment per policy contracts and SOPs, monitor TAT, productivity, accuracy, and customer satisfaction, and lead digitalisation and system enhancements with IT, product and vendor partners.

Qualifications

• Bachelor's degree in insurance, medicine, nursing, biomedical science, pharmacy, health sciences, business administration, or related disciplines.
• 7–10 years of experience in Health Claims operations.
• 3+ years of people management experience.
• Experience managing TPAs, healthcare providers, and vendor performance.
• Strong knowledge of medical and health insurance claims assessment.
• Good understanding of insurance and takaful products.
• Knowledge of healthcare billing, medical procedures, and hospital claims administration.
• Knowledge of BNM regulations, industry guidelines, and claims governance requirements.
• Experience with claims administration systems and workflow management tools.
• Data analytics, reporting, and dashboard interpretation skills.

Responsibilities

• Lead end-to-end Health Claims operations (hospitalization, surgical, outpatient, medical reimbursement, and group medical claims).
• Ensure claims are assessed fairly, consistently, and in accordance with policy contracts, SOPs, and regulatory requirements.
• Monitor and improve claims turnaround time (TAT), productivity, accuracy, and customer satisfaction.
• Lead claims digitalisation initiatives and system enhancements, including requirements gathering, UAT, implementation, and post-production monitoring.
• Collaborate with IT, product, underwriting, and external vendors to enhance claims capabilities and STP.
• Ensure compliance with internal policies, SOPs, BNM regulations, takaful/insurance standards, and governance requirements.
• Lead TPAs relationships to ensure service quality, turnaround time, operational efficiency, and contractual compliance.
• Lead claims reporting and analytics to identify trends, operational issues, leakage risks, and improvement opportunities.
• Lead, coach, develop, and motivate the Claims team; support succession planning and performance management initiatives.

Skills

Health claims operations

People management

Vendor management

Data analytics

Claims assessment

Regulatory compliance

Stakeholder collaboration

System/workflow management

Leadership and coaching

TPA management

Education

Bachelor's degree in related disciplines

Tools

Workflow management tools

Claims administration systems

Job description

FWD Malaysia Holdings Sdn Bhd is seeking a leader to head the end-to-end Health Claims operations, covering hospitalization, surgical, outpatient, medical reimbursement, and group medical claims.

You will drive fair, consistent claims assessment per policy contracts and SOPs, monitor TAT, productivity, accuracy, and customer satisfaction, and lead digitalisation and system enhancements with IT, product and vendor partners.