Healthcare Claims Specialist: Precise, Impactful Processing

Ambition; Kuala Lumpur; On-site; MYR 36,000 - 60,000; Full time

Job summary

Ambition is seeking a dedicated Claims Executive in Petaling Jaya to evaluate and process medical claims, ensuring accuracy and timely handling. You will verify submissions for completeness and regulatory compliance, assess eligibility based on policy terms, and coordinate with insurers to secure approvals.

You will manage records and respond to member inquiries with clarity and professionalism. The role demands attention to detail, experience in health insurance or healthcare claims, and strong

Qualifications

• Experience in processing medical/healthcare claims.
• Solid grounding in insurance products, policy structures and terminology.
• Meticulous attention to detail with accuracy.

Responsibilities

• Evaluate and process submitted medical claims accurately and within agreed timeframes.
• Scrutinise claim submissions to confirm completeness and regulatory compliance.
• Assess policy terms to determine member eligibility and coverage entitlements.
• Coordinate with insurance providers to facilitate approvals and resolve outstanding issues.
• Maintain well-organised and up-to-date records across all claim activities.
• Act as first point of contact for member queries, delivering clear and professional responses.

Skills

Claims processing

Insurance knowledge

Attention to detail

Communication skills

High-volume environment

Job description

Ambition is seeking a dedicated Claims Executive in Petaling Jaya to evaluate and process medical claims, ensuring accuracy and timely handling. You will verify submissions for completeness and regulatory compliance, assess eligibility based on policy terms, and coordinate with insurers to secure approvals.

You will manage records and respond to member inquiries with clarity and professionalism. The role demands attention to detail, experience in health insurance or healthcare claims, and strong