Healthcare Policy Data Management Executive

OneWorks Sdn Bhd; Kuala Lumpur; Presencial; MYR 48 000 - 72 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical coverage

Career development

Training programmes

Work-life balance

Resumo da oferta

OneWorks Sdn Bhd is seeking a detail-oriented Policy Insurance Data Management Executive to join our Healthcare TPA team. You will ensure accurate setup, maintenance, and administration of policies, member eligibility, benefit plans, and related data within our core system.

The role requires strong data handling, analytical thinking, and the ability to work with insurers, corporate clients, and IT to meet SLA targets while maintaining high data quality and compliance in the healthcare and

Qualificações

• Diploma or degree in Computer Science, Information Technology, Insurance, Healthcare Administration, Business Administration or related field.
• Fresh graduates or at least 2 years in healthcare TPA operations, data management, or policy setup.
• Strong written and verbal communication in English; Bahasa Malaysia is a plus.

Responsabilidades

• Data entry, validation, and reconciliation of member data, policy configurations, endorsements and benefit updates.
• Maintain and administer membership eligibility and policy administration systems; troubleshoot issues.
• Collaborate with IT, insurers, brokers, and internal teams to ensure SLA-driven turnaround.
• Ensure data accuracy, compliance, and secure handling of confidential information.
• Assist with system testing and user acceptance testing (UAT) as needed.

Conhecimentos

Data management

Data validation

Analytical thinking

Problem solving

Attention to detail

Microsoft Excel

SQL knowledge

API integration concepts

SFTP file transfer

Formação académica

Diploma or Bachelor’s degree

Professional Certificate in Healthcare Administration

Ferramentas

Core healthcare management systems

Claims management systems

Microsoft Office

Descrição da oferta de emprego

We are seeking a detail-oriented and proactive Policy Insurance Data Management Executive to join our Healthcare Third-Party Administrator (TPA) team. This role is responsible for ensuring the accurate setup, maintenance, and administration of insurance policies, member eligibility, benefit plans, and policy-related data within our core healthcare management system.

The successful candidate will play a critical role in managing member data, policy configurations, endorsements, and benefit updates while ensuring data accuracy, compliance, and timely turnaround in accordance with Service Level Agreements (SLA). You will work closely with insurance companies, corporate clients, internal departments, and the IT team to support smooth business operations and deliver excellent service to our stakeholders.

This position is ideal for individuals who enjoy working with data, possess strong analytical and problem-solving skills, and are passionate about maintaining high standards of operational excellence in the healthcare and insurance industry.

Key responsibilities

1. Data Management

• Strong data entry and data validation skills.
• High level of accuracy and attention to detail.
• Ability to manage large volumes of member data.
• Ability to perform data reconciliation and auditing.
• Strong analytical and problem-solving skills.

2. System Administration

• Experience in managing membership or policy administration systems.
• Ability to troubleshoot system-related issues.
• Ability to coordinate effectively with IT and system vendors.
• Familiarity with system testing and User Acceptance Testing (UAT).

3. Insurance Administration

• Ability to interpret insurance contracts and benefit schedules.
• Understanding of policy rules, eligibility criteria, and exclusions.
• Experience in member enrollment, deletion, and endorsement processing.
• Ability to configure benefit plans accurately.

4. Customer Service

• Ability to liaise with insurers, brokers, corporate clients, hospitals, and internal stakeholders.
• Ability to handle inquiries professionally and within service standards.

5. Personal Attributes

• Meticulous and detail-oriented.
• Strong sense of accountability and ownership.
• Ability to work under pressure and meet deadlines.
• Good time management and prioritization skills.
• Team player with positive attitude.
• Ability to handle confidential information with integrity.

What we're looking for

• 1. Diploma, Advanced/Higher/Graduate Diploma, Bachelor’s Degree, Professional Certificate in Computer Science, Information Technology, Insurance, Healthcare Administration, Business Administration, Management or any related discipline AND/OR
• 2. Fresh graduate or minimum 2 year of relevant working experience in the Healthcare Third Party Administration (TPA) operations, medical insurance administration, employee benefits administration, membership administration, data management and system administration or insurance policy setup and maintenance.
• 3. Excellent written and verbal communication skills in English; proficiency in Bahasa Malaysia is highly desirable.
• 4. Proficiency in using claims management systems and Microsoft Office applications
• 5. Ability to multitask and manage multiple data submission simultaneously.
• 6. Strong organisational skills with meticulous attention to detail.
• 7. Customer-focused approach with the ability to handle enquiries professionally and courteously.
• 8. Problem-solving mindset with the ability to work independently and as part of a team.

9. Technical Knowledge

Understanding of:

• Medical insurance policies
• Employee benefits administration
• ASO (Administrative Services Only) programs
• Membership eligibility management
• Schedule of Benefits (SOB)
• Endorsement processing
• Healthcare provider network operations

10. Knowledge of:

• Database management principles
• Data validation and quality control
• System configuration and maintenance
• SFTP file transfer processes
• Excel (Advanced)
• SQL knowledge (advantageous)
• API integration concepts (advantageous)
• Advanced Microsoft Excel (VLOOKUP, XLOOKUP, Pivot Table, Power Query).
• Experience with healthcare or insurance core systems.
• Knowledge of medical claims and Guarantee Letter (GL) processes.
• Experience in bulk data migration and data cleansing.
• Understanding of API, SFTP, and automated file processing.

What we offer

At OneWorks Assistance Sdn. Bhd., we are committed to creating a supportive and professional work environment. We offer competitive remuneration packages, opportunities for career development and advancement, and ongoing training programmes to enhance your skills and knowledge in the healthcare administration sector. We believe in promoting work-life balance and provide a collaborative workplace culture where your contributions are valued and recognised. Additional benefits include medical coverage and access to employee wellness initiatives to support your overall well-being.

About us

OneWorks Assistance Sdn. Bhd. is a leading healthcare solutions provider committed to delivering efficient and reliable medical administration services. With a focus on bridging the gap between patients, healthcare providers, and insurance companies, we pride ourselves on our expertise in healthcare guarantee letter management and related administrative services. Our mission is to simplify healthcare access whilst maintaining the highest standards of professionalism and compliance. We are dedicated to building lasting partnerships with our clients and creating a workplace where talented professionals can thrive and make a meaningful impact in the healthcare industry.

Apply now

If you are interested in joining our team and believe you have the skills and experience to excel in this role, we would like to hear from you. Please submit your CV, cover letter, and any relevant certifications to our recruitment team. We look forward to considering your application and discussing how you can contribute to OneWorks Sdn Bhd.

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Computer Software & Networking 101-1,000 employees

OneWorks incorporated in 1999 as an innovative provider of electronic services (e-services) to the financial and insurance industry.

Through our carfix.my platform, we are currently connecting insurance companies, car repair shops and roadside assistance provider to provide assistance to vehicle owner in the event their vehicle is met with accident or breakdowns.

OneWorks incorporated in 1999 as an innovative provider of electronic services (e-services) to the financial and insurance industry.

Through our carfix.my platform, we are currently connecting insurance companies, car repair shops and roadside assistance provider to provide assistance to vehicle owner in the event their vehicle is met with accident or breakdowns.

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