Senior Executive Claims Management

Protecthealth Corporation; Sepang; On-site; MYR 100,000 - 150,000; Full time

Job summary

ProtectHealth Corporation is seeking a Senior Executive in Claims Management to oversee claims processes and ensure compliance. This role includes improving departmental procedures, collaborating with internal teams, and providing insights through data analysis. The ideal candidate holds a Bachelor’s degree in a related field and has extensive experience in claims management with strong analytical and communication skills.

Benefits

Competitive remuneration and benefits

Career development opportunities

Inclusive work culture

Flexible work arrangements

Wellness and employee wellbeing programs

Qualifications

• Minimum 5 years' experience in claims management or similar role.
• Experience with SPIKPA or healthcare sector is an advantage.
• Involvement in system enhancement or healthcare product development is preferred.

Responsibilities

• Manage day-to-day operations of the Claims Management function.
• Develop rules and guidelines for medical and healthcare-related claims.
• Generate accurate financial and statistical reports for claims.

Skills

Communication

Analytical

Organizational

Collaborative

Education

Bachelor’s degree in Medical Sciences

Bachelor’s degree in Pharmacy

Bachelor’s degree in Biotechnology

Related health discipline

Tools

Microsoft Office

Job description

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About the role

The Senior Executive, Claims Management, is responsible for supporting and coordinating all claims processing and operational activities. This role plays a key part in ensuring timely, accurate, and efficient handling of both medical and non-medical claims, contributing to service excellence and operational efficiency.

What you'll be doing

1. Manage the day-to-day operations of the Claims Management function to ensure turnaround time (TAT) compliance for processes including registration, provision, adjudication, approval, and settlement.
2. Assist in developing comprehensive rules and guidelines for medical and healthcare-related claims.
3. Contribute to the documentation, review, and continuous improvement of departmental policies, procedures, and workflows.
4. Generate accurate and timely financial/statistical reports for claims, recovery, receivables, and provisioning.
5. Collaborate with Customer Relationship Management and other internal teams to resolve customer complaints and enhance satisfaction.
6. Conduct data analysis and prepare periodic reports or presentations for internal use or management review.
7. Review and resolve medical and non-medical claims by validating documentation, determining benefits, initiating payments, or drafting denial communications.
8. Perform other duties as assigned to support claims operations and departmental goals.

What we're looking for

• Minimum 5 years' experience in claims management or similar role.
• Bachelor’s degree in Medical Sciences, Pharmacy, Biotechnology, or related health discipline.
• Experience with SPIKPA or healthcare sector is an advantage.
• Involvement in system enhancement or healthcare product development is preferred.
• Strong verbal and written communication skills.
• Proficiency in Microsoft Office; adaptable to new systems and software.
• Strong analytical, organizational, and collaborative skills.
• Ability to work under pressure in a fast-paced environment.

What we offer

At PROTECTHEALTH CORPORATION SDN. BHD., we support personal and professional growth through:

• Competitive remuneration and benefits
• Career development opportunities
• Inclusive work culture
• Flexible work arrangements
• Wellness and employee wellbeing programs

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Your application will include the following questions:

• What's your expected monthly basic salary?
• Which of the following qualifications do you have?

ProtectHealth Corporation Sdn Bhd, established in 2016 under the Ministry of Health, Malaysia, is a not-for-profit company managing healthcare financing initiatives.

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