Senior Claims Operations Leader

HMI Managed Healthcare; Kampung Malaysia Tambahan; On-site; MYR 120,000 - 180,000; Full time

Job summary

HMI Managed Healthcare is seeking an experienced Claims Manager to lead our claims assessment team and oversee end-to-end processing of patient claims. You will ensure claims are processed accurately and in line with company policies and SLAs, while driving performance, quality, and stakeholder satisfaction.

The role requires strong technical claims knowledge, leadership experience, and the ability to coach teams, optimize processes, and deliver insightful reports.

Qualifications

• Six years in claims handling with at least 3 years in a leadership role.
• Strong technical claims knowledge and sound judgement.
• Excellent communication and interpersonal skills for stakeholder engagement.
• Detail-oriented, well-organised and customer-focused.
• Ability to manage multiple priorities under pressure and deliver results.

Responsibilities

• Oversee processing of patient claims ensuring accuracy, timeliness and compliance with SLAs.
• Provide coaching and guidance to claims assessors and resolve complex claims.
• Monitor outstanding claims, payment cycles and quality to ensure efficient processing.
• Lead onshore and offshore teams, track KPIs and drive performance improvements.
• Prepare and present claims reports and supportHead of Claims with data analysis.
• Ensure compliance with regulatory requirements and internal SOPs.
• Identify process improvements and support system enhancements.

Skills

Claims knowledge

Analytical skills

Communication

Leadership

Team coaching

Education

Bachelor's degree

Insurance certifications (advantage)

Job description

HMI Managed Healthcare is seeking an experienced Claims Manager to lead our claims assessment team and oversee end-to-end processing of patient claims. You will ensure claims are processed accurately and in line with company policies and SLAs, while driving performance, quality, and stakeholder satisfaction.

The role requires strong technical claims knowledge, leadership experience, and the ability to coach teams, optimize processes, and deliver insightful reports.