Life & Health Claims Investigator

Great Eastern; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

A leading insurance company based in Kuala Lumpur seeks a claims investigator to handle Life and Health claims. The ideal candidate will need a university degree and at least 2 years of relevant experience in claims analysis. The role requires strong problem-solving skills, effective communication, and a customer-oriented attitude. Responsibilities include conducting investigations, reviewing cases, and preparing recommendations for claims decisions. This position offers an opportunity to work with medical records and ensure proper documentation.

Qualifications

• At least 2-year experience in claims analysis with a good knowledge of the insurance industry.
• Other professional qualification would be an advantage.

Responsibilities

• Conduct investigation to substantiate claim decision for Life and Health claims.
• Review and study cases and develop investigation plan.
• Obtain duly completed Letter of Authorisation/Consent and Letter of Declaration from policyholders.
• Initiate and follow up with clinic/doctor/hospital to obtain details of the policyholder's medical history and records.
• Consolidate investigative findings and prepare recommendation for claim decision making.
• Proper documentation of investigation evidences.
• Process/handle medical report fee due to clinic/doctor/hospital.

Skills

Problem solving and decision making

Good written and verbal communication

Customer oriented

Integrity and trustworthy

Organised and properly planned

Teamwork and cooperation

Education

University Degree in any discipline

Job description

A leading insurance company based in Kuala Lumpur seeks a claims investigator to handle Life and Health claims. The ideal candidate will need a university degree and at least 2 years of relevant experience in claims analysis. The role requires strong problem-solving skills, effective communication, and a customer-oriented attitude. Responsibilities include conducting investigations, reviewing cases, and preparing recommendations for claims decisions. This position offers an opportunity to work with medical records and ensure proper documentation.