Senior Claims Examiner, A&H Claims

Chubb; Malaysia; On-site; MYR 78,000 - 123,000; Full time

Job summary

Chubb is seeking a claims operations professional to ensure delivery of best practice claims processes and consistent service within targets. The role involves managing the net claims expense budget and owning the customer experience, with close collaboration across suppliers and stakeholders in Malaysia.

Key tasks include auditing cashless and hospitalisation claims, overseeing payment processing, performing sanctions checks, and regular reviews of aging files.

Responsibilities

• Assess hospitalisation and surgical claims on reimbursement basis.
• Audit cashless hospitalisation and surgical claims.
• Oversee payment processing for bordereaux medical claims.
• Perform sanctions checks and ensure regulatory compliance.
• Monitor performance of the appointed TPA and liaise on issues.
• Maintain communication with management and underwriting teams.
• Provide feedback on visible claims trends.
• Review aging files monthly, quarterly and yearly.
• Participate in ad hoc projects as assigned.

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.