Manager, Claims

FWD Malaysia Holdings Sdn Bhd; Kuala Lumpur; On-site; MYR 180,000 - 300,000; Full time

Job summary

FWD Malaysia Holdings Sdn Bhd is seeking a leader to head the end-to-end Health Claims operations, covering hospitalization, surgical, outpatient, medical reimbursement, and group medical claims.

You will drive fair, consistent claims assessment per policy contracts and SOPs, monitor TAT, productivity, accuracy, and customer satisfaction, and lead digitalisation and system enhancements with IT, product and vendor partners.

Qualifications

• Bachelor's degree in insurance, medicine, nursing, biomedical science, pharmacy, health sciences, business administration, or related disciplines.
• 7–10 years of experience in Health Claims operations.
• 3+ years of people management experience.
• Experience managing TPAs, healthcare providers, and vendor performance.
• Strong knowledge of medical and health insurance claims assessment.
• Good understanding of insurance and takaful products.
• Knowledge of healthcare billing, medical procedures, and hospital claims administration.
• Knowledge of BNM regulations, industry guidelines, and claims governance requirements.
• Experience with claims administration systems and workflow management tools.
• Data analytics, reporting, and dashboard interpretation skills.

Responsibilities

• Lead end-to-end Health Claims operations (hospitalization, surgical, outpatient, medical reimbursement, and group medical claims).
• Ensure claims are assessed fairly, consistently, and in accordance with policy contracts, SOPs, and regulatory requirements.
• Monitor and improve claims turnaround time (TAT), productivity, accuracy, and customer satisfaction.
• Lead claims digitalisation initiatives and system enhancements, including requirements gathering, UAT, implementation, and post-production monitoring.
• Collaborate with IT, product, underwriting, and external vendors to enhance claims capabilities and STP.
• Ensure compliance with internal policies, SOPs, BNM regulations, takaful/insurance standards, and governance requirements.
• Lead TPAs relationships to ensure service quality, turnaround time, operational efficiency, and contractual compliance.
• Lead claims reporting and analytics to identify trends, operational issues, leakage risks, and improvement opportunities.
• Lead, coach, develop, and motivate the Claims team; support succession planning and performance management initiatives.

Skills

Health claims operations

People management

Vendor management

Data analytics

Claims assessment

Regulatory compliance

Stakeholder collaboration

System/workflow management

Leadership and coaching

TPA management

Education

Bachelor's degree in related disciplines

Tools

Workflow management tools

Claims administration systems

Job description

Lead and oversee the end-to-end Health Claims operations, including hospitalization, surgical, outpatient, medical reimbursement, and group medical claims

Ensure claims are assessed fairly, consistently, and in accordance with policy contracts, Claims SOPs, medical guidelines, and regulatory requirements

Monitor and improve claims turnaround time (TAT), productivity, accuracy, and customer satisfaction

Lead claims digitalisation initiatives and system enhancements, including business requirement gathering, UAT, implementation, and post-production monitoring

Collaborate with IT, product, underwriting, and external vendors to enhance claims capabilities and straight-through processing (STP)

Ensure compliance with internal policies, Claims SOPs, BNM regulatory requirements, Takaful/Insurance standards, and FWD Group governance requirements

Lead and manage Third Party Administrator (TPA) relationships to ensure service quality, turnaround time, operational efficiency, and contractual compliance

Lead claims reporting and analytics to identify trends, operational issues, leakage risks, and improvement opportunities

Lead, coach, develop, and motivate the Claims team to enhance technical competency, productivity, and customer-centric culture

Support succession planning, capability building, and performance management initiatives

About you

Bachelor's degree in insurance, Medicine, Nursing, Biomedical Science, Pharmacy, Health Sciences, Business Administration, or related disciplines

Minimum 7-10 years of experience in Health Claims operations

Minimum 3 years of people management experience

Experience managing TPAs, healthcare providers, and vendor performance

Strong knowledge of medical and health insurance claims assessment

Good understanding of insurance and takaful products

Strong knowledge of healthcare billing, medical procedures, and hospital claims administration

Knowledge of BNM regulations, industry guidelines, and claims governance requirements

Experience with claims administration systems and workflow management tools

Data analytics, reporting, and dashboard interpretation skills

FWD Malaysia Holdings Sdn Bhd (FWD Malaysia) is the financial holding company for FWD Takaful & FWD Insurance Bhd, aim to change how people feel about takaful & insurance. Through its subsidiaries it offers family takaful and life insurance, including medical, CI protection, savings plans and investment-linked solutions, and is regulated by Bank Negara Malaysia under Financial Services Act 2013. It is part of FWD Group (1828.HK), a pan-Asian life and health insurer founded in 2013, serving over 38Ms clients across 10 of the world’s fastest-growing insurance markets, including BRI Life in Indonesia, and listed on the Hong Kong Stock Exchange Main Board (stock code 1828). More info: fwd.com.my

FWD Malaysia Holdings Sdn Bhd (FWD Malaysia) is the financial holding company for FWD Takaful & FWD Insurance Bhd, aim to change how people feel about takaful & insurance. Through its subsidiaries it offers family takaful and life insurance, including medical, CI protection, savings plans and investment-linked solutions, and is regulated by Bank Negara Malaysia under Financial Services Act 2013. It is part of FWD Group (1828.HK), a pan-Asian life and health insurer founded in 2013, serving over 38Ms clients across 10 of the world’s fastest-growing insurance markets, including BRI Life in Indonesia, and listed on the Hong Kong Stock Exchange Main Board (stock code 1828). More info: fwd.com.my