Medical Claims Processor (GL, Admission, Inpatient, Outpatient)

Ambition; Subang Jaya; Presencial; MYR 40.000 - 67.000; Jornada completa

Descripción de la vacante

Ambition is seeking a dedicated Claims Executive to join their healthcare insurance services team in Petaling Jaya. If you have a keen eye for detail and a passion for delivering accurate, efficient support in a fast-paced environment, this permanent opportunity could be your next great move.

You will evaluate and process medical claims, check submissions for completeness and compliance, assess coverage eligibility, and coordinate with insurers, hospitals and providers to secure approvals and

Formación

• Experience in insurance operations, medical claims processing, managed care, or healthcare administration.
• Knowledge of Guarantee Letter issuance, hospital admissions, inpatient and outpatient claims, and medical benefits administration.
• Ability to assess coverage eligibility, interpret policy benefits, and process claims accurately.
• Experience coordinating with members, hospitals, providers, and insurers to facilitate admissions, claims and resolutions.
• Strong attention to detail with good communication and stakeholder management skills.

Responsabilidades

• 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

Conocimientos

Insurance operations

Medical claims processing

Managed care

Healthcare administration

Guarantee Letter issuance

Policy benefits interpretation

Claims coordination

Stakeholder management

Attention to detail

Communication skills

Descripción del empleo

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.

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:

• Experience in insurance operations, medical claims processing, managed care, or healthcare administration
• Strong knowledge of Guarantee Letter (GL) issuance, hospital admissions, inpatient and outpatient claims, and medical benefits administration
• Ability to assess coverage eligibility, interpret policy benefits, and process claims accurately in accordance with insurer and client requirements
• Experience coordinating with members, hospitals, healthcare providers, and insurers to facilitate admissions, claims, and case resolutions
• Proven ability to manage high claim volumes and multiple cases simultaneously in a fast-paced, deadline-driven environment
• Meticulous attention to detail with strong communication, problem-solving, and stakeholder management skills

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