Medical Claims Processor

Ambition; Kuala Lumpur; On-site; MYR 36,000 - 60,000; Full time

Job summary

Ambition is seeking a dedicated Claims Executive in Petaling Jaya to evaluate and process medical claims, ensuring accuracy and timely handling. You will verify submissions for completeness and regulatory compliance, assess eligibility based on policy terms, and coordinate with insurers to secure approvals.

You will manage records and respond to member inquiries with clarity and professionalism. The role demands attention to detail, experience in health insurance or healthcare claims, and strong

Qualifications

• Experience in processing medical/healthcare claims.
• Solid grounding in insurance products, policy structures and terminology.
• Meticulous attention to detail with accuracy.

Responsibilities

• Evaluate and process submitted medical claims accurately and within agreed timeframes.
• Scrutinise claim submissions to confirm completeness and regulatory compliance.
• Assess policy terms to determine member eligibility and coverage entitlements.
• Coordinate with insurance providers to facilitate approvals and resolve outstanding issues.
• Maintain well-organised and up-to-date records across all claim activities.
• Act as first point of contact for member queries, delivering clear and professional responses.

Skills

Claims processing

Insurance knowledge

Attention to detail

Communication skills

High-volume environment

Job description

Are You Ready to Build a Career at the Heart of Healthcare Insurance?

If you have a keen eye for detail and a passion for delivering accurate, efficient support in a dynamic environment, this permanent opportunity in Petaling Jaya could be your next great move. Our client is a well-established healthcare insurance services provider playing a critical role in connecting insurers, members, and healthcare providers - and they're looking for a dedicated Claims Executive to join their team.

Why Apply?

This is your chance to be part of a purpose-driven organisation where your work has a direct and tangible impact. You'll operate at the intersection of healthcare and insurance, gaining hands-on experience in a fast-paced, people-focused setting where accuracy and service excellence are genuinely valued.

The Role

Day to day, you'll be responsible for:

• Evaluating and processing submitted medical claims accurately and within agreed timeframes
• Scrutinising claim submissions to confirm completeness and regulatory compliance
• Assessing policy terms to determine member eligibility and coverage entitlements
• Coordinating with insurance providers to facilitate approvals and resolve outstanding issues
• Maintaining well-organised and up-to-date records across all claim activities
• Acting as a first point of contact for member queries, delivering clear and professional responses

What We're Looking For

The ideal candidate will bring:

• Practical experience in a claims processing role within the insurance or healthcare sector
• A solid grounding in insurance products, policy structures, and industry terminology
• Meticulous attention to detail with a strong commitment to accuracy
• Effective communication and interpersonal skills suited to a member-facing environment
• The resilience and composure to perform well in a high-volume, fast-moving setting

JTK Number: JTKSM 995 | Company Registration Number: 201301019088 (1048918-T)