Senior Claims Examiner, A&H Claims

Chubb Ltd.; Malaysia; On-site; MYR 40,000 - 60,000; Full time

Job summary

Chubb Ltd. is looking for a dedicated professional to manage best practice claims operations in Malaysia. The role involves oversight of hospitalisation and surgical claims, ensuring compliance, and liaising with stakeholders.

Key responsibilities include claims assessment, payment processing, and performance monitoring of service providers. The candidate will maintain constant communication with management and underwriting teams and participate in various projects as assigned.

Responsibilities

• Assessment of Group and Individual hospitalisation and surgical claims.
• Auditing cashless claims for hospitalisation and surgical claims.
• Overseeing payment processing for bordereaux medical claims.
• Performing sanctions checks on claims compliance.
• Monitoring performance of the appointed TPA.
• Maintaining communication with management and underwriting teams.
• Providing feedback on claims trends.
• Conducting reviews of aging files.
• Participating in Ad Hoc projects or tasks.

Job description

Key Objective

The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.

Key Accountabilities & 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.