Individual Claims Management, Analyst

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

Job summary

A leading insurance provider in Kuala Lumpur seeks a Claims Manager to oversee individual claims management. The role includes team leadership in pre-certification processes, ensuring adherence to quality standards and efficiency benchmarks. Candidates should possess a Bachelor's Degree in Medicine and at least 2 years' relevant experience in the health insurance sector. This position offers career growth and a supportive work environment focused on improving community health.

Benefits

Wellbeing tools and programmes

Career growth opportunities

Diverse team culture

Qualifications

• Minimum 2 years of experience in health insurance or related field.

Responsibilities

• Support and lead a team of assessors in pre‑certification and case management.
• Ensure quality audits for team members are conducted.
• Pre‑certify cases and ensure accurate issuance of guarantee letters.
• Handle fee disputes and ensure compliance with company guidelines.
• Assist in monitoring document assignments and headcount.

Skills

Claims assessment

Medical report knowledge

Health Insurance Policy knowledge

English

Bahasa Malaysia

Education

Bachelor’s Degree in Medicine or medical fields

Job description

About the Role

This job is about managing individual claims at AIA, ensuring quality and cost containment in healthcare. You might like this job because it offers career growth opportunities and a chance to shape a healthier future for communities.

Responsible for performing pre‑certification; prospective, concurrent and retrospective review of hospitalization; and to ensure that cost containment measures are carried out without compromising on the care quality and service standards.

Roles and Responsibilities

• To support and lead a team of assessors in pre‑certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company’s requirements and guidelines.
• To ensure quality audits are done for the respective team members.
• To pre‑certify cases for issuance of guarantee letter in compliance to Company’s requirements and guidelines assist the team target productivity benchmark.
• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
• To assist in the assignment and monitoring of all documents received in their respective team’s queues.
• To assist WFM team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the GL process.
• To ensure huddles and communications are carried out as per the agreed frequency.
• To ensure coaching and engagement activities are carried out for performance improvement and cost containment.
• To ensure that cases of fee disputes are handled and resolved within targeted TAT.
• To ensure that error rate in GL issuance is less that the target.
• To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements.

Minimum Job Requirements

• Education: Bachelor’s Degree in Medicine or medical fields
• Years of Experience: Minimum 2 years of experience
• Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge
• Industry: Health Insurance, Third‑Party Administrator, Hospitals, Clinics, Medical Labs
• Language: English and Bahasa Malaysia

Company Benefits

We offer a range of wellbeing tools and programmes to help you think well, feel well, plan well and live well.

Opportunities for career growth

With our diverse up‑skilling, mentorship, job mobility and career experiences, we will help shape your career, your way.

Diverse team culture

It's our differences that make us better together. We empower you to be your best and make a difference in your own unique ways.

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.

Do you believe in helping shape a better, more sustainable future? As the largest listed company on the Hong Kong Stock Exchange, we've been proudly making a difference for people and communities across Asia for over a century. And we build on this every day with our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030. Source: AIA Careers Page