Insurance Executive / Claims Executive

Private Advertiser; Malacca City; On-site; MYR 39,000 - 61,000; Full time

Job summary

Private Advertiser in Malaysia is seeking a Claims Executive to manage a portfolio of clients and support end-to-end claims for General and Health Insurance. You will handle the full lifecycle from registration to final settlement, ensuring accurate, timely processing.

You will liaise with clients, insurers, loss adjusters, hospitals, and TPAs, and verify eligibility while maintaining compliant records and preparing regular reports. Strong service and attention to detail are essential.

Responsibilities

• Manage claims through full lifecycle from registration to final settlement
• Register claims with insurers within 24 hours and follow through to timely settlement
• Prepare, review, and submit claim forms with supporting documents
• Verify submissions including straightforward claims
• Update and maintain claims status in internal systems
• Liaise with clients, insurers, loss adjusters, lawyers, clinics/hospitals, and TPAs
• Act as main contact for clients via phone and email
• Explain settlement decisions to clients clearly
• Monitor outstanding claims and documentation
• Maintain organized claims records and prepare regular reports
• Support data preparation, reporting, and testing initiatives
• Ensure compliance with regulatory requirements including PDPA

Job description

The Claims Executive is responsible for managing a portfolio of clients and supporting the end-to-end claims process for General and Health Insurance products. This role ensures accurate, timely, and compliant claims handling while delivering strong client service and operational support.

Manage and administer claims throughout the full lifecycle, from registration to final settlement

Ensure all claims are registered with insurers promptly (within 24 hours) and followed through to timely settlement, including payout processing

Prepare, review, and submit claim forms and supporting documentation, ensuring completeness and compliance with policy terms and requirements

Verify and validate claims submissions, including assessing straightforward personal and non-complex commercial insurance claims

Update and maintain claims status in internal systems and platforms

Liaise with clients, insurers, loss adjusters, lawyers, clinics/hospitals, and third-party administrators to facilitate fair and timely claim outcomes

Act as the main point of contact for clients, handling enquiries on claims, insurance coverage, and pre-authorisation via phone and email

Communicate claim outcomes clearly to clients, including explanations of settlement decisions

Verify applicant eligibility against policy or grant criteria and notify applicants of incomplete or unsuccessful submissions

Monitor and follow up on outstanding claims, documentation, and settlement matters

Maintain accurate and organized documentation, including proper electronic and physical filing of claims records

Prepare regular claims reports, including activity reports, bordereaux, claims logs, and analysis

Support claims data preparation, reporting, and automation/testing initiatives

Provide general administrative and operational support to the Claims Team, including report preparation and documentation

Ensure compliance with regulatory requirements, company policies, and guidelines, including PDPA and confidentiality standards

Perform ad-hoc duties as assigned