Medical Claims Processor

Ambition; Kuala Lumpur; On-site; MYR 36,000 - 58,000; Full time

Job summary

Ambition in Malaysia is seeking a dedicated Claims Executive in Petaling Jaya to join a well-established healthcare insurance services provider. You will process and evaluate medical claims, ensuring accuracy and timely handling in a fast-paced, member-facing environment.

The role requires practical experience in claims processing, strong knowledge of insurance products, and a meticulous attention to detail.

Qualifications

• Experience in a claims processing role within the insurance or healthcare sector.
• 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 for a member-facing environment.
• Resilience and composure in a high-volume, fast-moving setting.

Responsibilities

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

Skills

Claims processing

Insurance knowledge

Attention to detail

Communication skills

Customer service

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