Impactful Medical Claims Assessor

MiCare Sdn Bhd

Shah Alam

On-site

MYR 45,000 - 78,000

Full time

14 days+

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Job summary

MiCare Sdn Bhd is seeking a Medical Claims Assessor to join our Bukit Jelutong-based team in Malaysia. You will evaluate medical claims, review supporting documents, and ensure accurate, timely processing in line with policy terms and regulatory guidelines.

You will investigate discrepancies, respond to inquiries, and monitor for potential fraud while maintaining high-quality customer service. A Diploma or higher in Medical Science/Nursing/Pharmacy/Insurance is preferred, with fluency in English

Qualifications

Diploma or higher in Medical Science, Nursing, Pharmacy, Insurance, or related field.
Experience in medical claims or TPA/Insurance industry is an advantage.
Must be computer literate with knowledge of Word, Excel, etc.
Good command of English and Bahasa Malaysia, both speaking and writing.

Responsibilities

Medical Claims Assessment & Processing: assesses and approves medical claims within required turnaround time per policies and regulations.
Claims Investigation & Resolution: clarifies details with providers/clients and resolves discrepancies.
Customer Inquiries & Communication: handles inquiries and informs clients of claim status.
Documentation, Compliance & Fraud Monitoring: maintains records and monitors for irregularities, reports suspected fraud.
Continuous Improvement & Additional Support: supports process improvements and ad hoc tasks.