Senior Claims Analyst

Tune Protect Group; Kuala Lumpur; On-site; MYR 42,000 - 66,000; Full time

Job summary

Tune Protect Group in Kuala Lumpur is seeking a Claims Analyst, Personal Accident to manage and process PA insurance claims from notification to settlement. You will evaluate documentation to confirm coverage and liability and ensure timely, fair resolutions.

You will investigate claims, liaise with claimants, brokers and medical providers, maintain accurate registrations and reserves, and monitor items to meet SLAs and BN Malaysia requirements.

Qualifications

• Process PA insurance claims from notification to settlement.
• Review documentation to determine coverage and liability.
• Investigate claims using medical and police reports when needed.
• Maintain compliance with Bank Negara Malaysia guidelines and internal policies.

Responsibilities

• Process and manage Personal Accident insurance claims from notification through to settlement.
• Review and assess claims documentation to determine coverage, validity, and extent of liability.
• Investigate claims thoroughly, including reviewing medical reports, police reports, and supporting documents where applicable.
• Evaluate claims and recommend settlement amounts within delegated authority limits.
• Liaise with claimants, agents, brokers, medical providers, adjusters, and other stakeholders to facilitate smooth claims handling.
• Ensure accurate claims registration, data entry, and reserving in accordance with company guidelines.
• Monitor and follow up on outstanding claims to ensure timely resolution and closure within service level agreements (SLAs).
• Identify suspicious or potentially fraudulent claims and escape for further investigation where necessary.
• Maintain accurate and complete claims records, ensuring timely updates in the system.
• Prepare reports and provide insights on claims trends, turnaround time (TAT), and operational performance.
• Provide prompt and professional responses to claims-related queries, ensuring high levels of customer satisfaction.
• Perform other duties as assigned from time to time.

Skills

PA claims processing

Documentation review

Liability assessment

Fraud detection

Stakeholder liaison

Data entry & registration

Reporting & analytics

Job description

The Claims Analyst, Personal Accident is responsible for managing and processing personal accident insurance claims efficiently and accurately from notification to settlement. This role involves evaluating claims documentation, determining policy coverage and liability, and ensuring prompt and fair claim resolutions in accordance with company policies and Bank Negara Malaysia regulations.

• Process and manage Personal Accident (PA) insurance claims from notification through to settlement
• Review and assess claims documentation to determine coverage, validity, and extent of liability in accordance with policy terms
• Investigate claims thoroughly, including reviewing medical reports, police reports, and supporting documents where applicable
• Evaluate claims and recommend settlement amounts within delegated authority limits
• Liaise with claimants, agents, brokers, medical providers, adjusters, and other stakeholders to facilitate smooth claims handling
• Ensure accurate claims registration, data entry, and reserving in accordance with company guidelines
• Monitor and follow up on outstanding claims to ensure timely resolution and closure within service level agreements (SLAs)
• Identify suspicious or potentially fraudulent claims and escape for further investigation where necessary
• Maintain accurate and complete claims records, ensuring timely updates in the system
• Ensure compliance with internal policies, audit requirements, and Bank Negara Malaysia’s Claims Settlement Practices (Minimum Standards)
• Prepare reports and provide insights on claims trends, turnaround time (TAT), and operational performance
• Provide prompt and professional responses to claims-related queries, ensuring high levels of customer satisfaction
• Perform other duties as assigned from time to time