Senior A&H Claims Examiner — Hospitalisation & Compliance

Chubb External; Malaysia; On-site; MYR 90,000 - 120,000; Full time

Job summary

Chubb External in Malaysia is seeking a claims operations professional responsible for delivering best practice claims processing, ensuring service levels, and managing customer experience. You will oversee hospitalisation and surgical claims, coordinate with TPAs, and monitor the net claims expense budget.

The role emphasizes compliance, stakeholder communication, and data-driven feedback on claims trends, with regular reviews of aging files and participation in ad hoc projects.

Responsibilities

• Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis.
• Auditing cashless claims for Group and Individual hospitalisation and surgical claims.
• Overseeing and facilitating payment processing for bordereaux medical claims.
• Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements.
• To monitor the performance of the appointed TPA and be proactive on liaising with TPA on resolving issues.
• Keeping constant communication with management and underwriting teams.
• Providing feedback on any visible claims trends.
• Monthly/Quarterly/Yearly review of aging files.
• Participate in Ad Hoc projects or tasks as assigned by supervisors.

Job description

Chubb External in Malaysia is seeking a claims operations professional responsible for delivering best practice claims processing, ensuring service levels, and managing customer experience. You will oversee hospitalisation and surgical claims, coordinate with TPAs, and monitor the net claims expense budget.

The role emphasizes compliance, stakeholder communication, and data-driven feedback on claims trends, with regular reviews of aging files and participation in ad hoc projects.