Individual Benefit Cashless, Claims

AIA Malaysia; Kuala Lumpur; On-site; MYR 60,000 - 90,000; Full time

Job summary

AIA Malaysia is seeking an experienced professional to provide technical medical expertise for claims decisions and to manage healthcare-related services for policyholders. The role requires handling claims, pre-certifications, and adherence to guidelines in a fast-paced environment.

Minimum of 5 years in insurance or medical fields is required; medical background is advantageous. Strong communication, multitasking, and problem-solving skills are essential for success.

Qualifications

• Bachelor’s degree or equivalent in any field.
• Minimum of 5 years working experience in insurance or medical industry.
• Candidate with medical insurance/nursing/medical science/hospital background will be an added advantage.
• Able to work in a fast-paced environment, independent, customer-focused, results-oriented & disciplined.
• Ability to multi-task, plan effectively and meet deadlines.
• Excellent written and oral communication skills.
• Good knowledge of using Microsoft Office and reporting tools.
• Able to adapt to constant changes in the organization.
• Strong analytical, problem-solving and decision-making abilities.
• Willing to work on rotating shifts.

Responsibilities

• Ensure completeness of Claims / Guarantee Letter; pre-certify documents per requirements and guidelines.
• Adjudicate medical claims following organization guidelines within authority limits.
• Establish covered medical insurance losses against benefits coverage and eligibility.
• Establish proof of loss by reviewing medical documentation; obtain additional information as required; escalate questionable claims.
• Maintain confidentiality of all claims information and internal controls.
• Identify and propose process improvements to increase operations efficiency.
• Ensure claims are processed within the specified turnaround time.
• Perform other responsibilities as assigned by supervisor to meet needs.

Skills

Customer focus

Communication skills

Multitasking

Analytical skills

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Job description

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

Responsible for providing technical medical expertise for claims decisions and resolution of customer enquiries and claims and managing healthcare related services provided to policy holders.

• Roles & Responsibilities:
• Ensure completeness of Claims / Guarantee Letter Pre-certify documents in compliance to Company’s requirements and guidelines
• Adjudicate medical claims by following the organization guidelines & within the assigned authority limit.
• Establish covered medical insurance losses against benefits coverage and eligibility.
• Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required).
• Ensure confidentiality of all claims information, inclusive of claims guidelines and internal controls.
• To identify Process improvement ideas & initiatives leading to greater operations effectiveness and efficiency..
• Ensure claims are processed within the specified turnaround time
• To performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements.

Minimum Job Requirements

• Bachelor’s degree or equivalent, in any field of study or with relevant background.
• Minimum of 5 years working experience preferably in the insurance or medical industry.
• Candidate with medical insurance/nursing/medical science/hospital background will be added advantage.
• Able to work in fast paced environment, independent, customer focused, result oriented & disciplined.
• Adaptable and able to work on own with minimal supervision.
• Ability to multi-task, plan effectively and meet deadlines.
• Service oriented/customers focus with sense of urgency and practice prioritization and critical thinking in jobs.
• Demonstrate good written and oral communication skills.
• Good knowledge of using Microsoft Office and others software applications especially reporting tools.
• Able to adapt in the face of constant changes in the organization.
• Good analytical, innovative and good in problem solving skill, ability to exercise judgment and take initiative to make decision and resolve problem(s).
• Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
• Able to work on rotating shifts

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.