Health Claims Transformation Lead

FWD Group Management Holdings Limited; Kuala Lumpur; On-site; MYR 180,000 - 260,000; Full time

Job summary

FWD Group is seeking a Manager, Claims in Kuala Lumpur to lead end-to-end health claims operations, ensuring fair assessments and compliance with policy contracts and regulatory standards.

You will drive digitalisation efforts, collaborate with IT, underwriting and TPAs, and mentor a claims team to improve TAT, accuracy, and customer satisfaction. A strong background in health insurance and governance is essential.

Qualifications

• Bachelor’s degree in insurance or related disciplines.
• 7–10 years of Health Claims operations experience.
• 3+ years of people management experience.
• Experience managing TPAs, providers and vendors.
• Experience in claims transformation or system implementations is a plus.

Responsibilities

• Lead end-to-end Health Claims operations, incl. hospitalization, surgical, outpatient, medical reimbursement and group medical claims.
• Ensure claims are assessed fairly, consistently and per policy contracts, SOPs, guidelines and regulations.
• Monitor and improve TAT, productivity, accuracy and customer satisfaction.
• Lead claims digitalisation initiatives, including requirements gathering, UAT, implementation and post-production monitoring.
• Collaborate with IT, product, underwriting and external vendors to enhance capabilities and STP.
• Maintain compliance with internal policies, regulatory requirements and governance.
• Manage Third Party Administrators (TPAs) relationships for service quality and efficiency.
• Lead claims reporting and analytics to identify trends and improvement opportunities.
• Provide management insights to support strategic decisions.
• Coach and develop the Claims team and support succession planning.

Skills

Medical claims knowledge

Insurance and takaful products

Healthcare billing and hospital claims

BNM regulations and governance

Data analytics and reporting

Project management and process-improv.

Education

Bachelor’s degree in insurance or related fields

Job description

FWD Group is seeking a Manager, Claims in Kuala Lumpur to lead end-to-end health claims operations, ensuring fair assessments and compliance with policy contracts and regulatory standards.

You will drive digitalisation efforts, collaborate with IT, underwriting and TPAs, and mentor a claims team to improve TAT, accuracy, and customer satisfaction. A strong background in health insurance and governance is essential.