Operation Specialist

Adecco; Kuala Lumpur; On-site; MYR 39,000 - 67,000; Full time

Job summary

Adecco in Malaysia is seeking a detail-oriented Claims Processor to support our insurance operations. You will process claims, verify documents, and ensure timely adjudication in line with SOPs. Training provided for fresh graduates.

Fluency in English is required; Cantonese/Mandarin language skills are a plus for cross-border inquiries. Diploma holders from science or health-related fields are encouraged to apply, with opportunities to grow within a global professional services team.

Qualifications

• Diploma qualification in any discipline is required.
• Science-related backgrounds are highly preferred.
• Fresh graduates are welcome with comprehensive training.

Responsibilities

• Process insurance claims within stipulated turnaround times.
• Review and verify claim documentation and supporting evidence.
• Perform claim adjudication by evaluating claim eligibility and policy coverage.
• Assess and calculate appropriate claim settlements according to policy provisions.
• Handle claims related to Group Medical and Employee Benefits.
• Respond to customer enquiries via phone and email.
• Handle inbound calls from Hong Kong customers in Cantonese.
• Liaise with stakeholders to resolve operational and claims-related issues.
• Ensure claims, calls, and emails meet quality standards and SOPs/SLAs.
• Maintain accurate records and documentation.
• Support ad-hoc operational assignments and achieve KPIs.

Skills

Attention to detail

Analytical thinking

Process-driven

Interpersonal skills

Time management

Independent worker

Team player

Deadline-driven

Education

Diploma

Biomedical Science

Biotechnology

Pharmacy

Nursing

Life Sciences

Health Sciences

Medical-related disciplines

Tools

Microsoft Excel

Microsoft Word

Job description

Our client is a global professional services organisation specialising in risk, insurance, and reinsurance solutions, with a strong presence across Asia-Pacific. Its regional business services team supports international markets through structured, high-quality operational and administrative services, offering exposure to regional insurance operations in a collaborative and professional environment.

Key Responsibilities

• Process insurance claims within stipulated turnaround times.
• Review and verify claim documentation and supporting evidence.
• Perform claim adjudication by evaluating claim eligibility and policy coverage.
• Assess and calculate appropriate claim settlements according to policy provisions.
• Handle claims related to Group Medical, Employee Benefits, health insurance, and related products.
• Respond to customer enquiries via phone and email.
• Handle inbound calls from Hong Kong customers in Cantonese.
• Liaise with internal and external stakeholders to resolve operational and claims-related issues.
• Ensure claims, calls, and email communications meet quality standards and comply with Standard Operating Procedures (SOPs) and Service Level Agreements (SLAs).
• Maintain accurate records and documentation.
• Support ad-hoc operational assignments as required.
• Achieve individual and team KPIs.

Requirements

Education

• Minimum Diploma qualification in any discipline.
• Candidates with Science-related backgrounds are highly preferred, including:
  • Biomedical Science
  • Biotechnology
  • Pharmacy
  • Nursing
  • Life Sciences
  • Health Sciences
  • Medical-related disciplines

Language Requirements

• Ability to speak Cantonese confidently to support Hong Kong customers.
• Good command of English, particularly written communication.
• Ability to understand Mandarin is preferred.
• Ability to read and write Chinese is an advantage.

Experience

Candidates with any of the following backgrounds are encouraged to apply:

• Claims adjudication
• Insurance claims processing
• Group Medical Insurance
• Employee Benefits (EB)
• Health or Medical Insurance
• Insurance Operations
• Policy Administration

Fresh graduates are welcome to apply as comprehensive training will be provided.

Technical Skills

Good proficiency in Microsoft Office applications, particularly:

• Microsoft Excel
• Microsoft Word

Personal Attributes

• Strong attention to detail.
• Good analytical and problem-solving skills.
• Process-driven and compliance-oriented mindset.
• Excellent interpersonal and communication skills.
• Strong organizational and time management abilities.
• Able to work independently and manage multiple priorities.
• Team player with a positive working attitude.
• Able to work within tight deadlines and turnaround times.
• High level of integrity and professionalism.
• Comfortable working in a fast-paced environment.