Senior Operations Executive - Claims

SECOND TALENT SDN. BHD.; Kuala Lumpur; On-site; MYR 60,000 - 80,000; Full time

Job summary

A leading insurance company in Kuala Lumpur is seeking an experienced Claims Manager to oversee complex claims and ensure compliance with regulations. The ideal candidate will have a Bachelor's degree, 2-3 years of experience in claims management, and strong analytical skills. Proficiency in Cantonese and Mandarin is preferred to communicate with clients. This role offers opportunities in a dynamic and digital-first environment.

Qualifications

• Minimum 2-3 years experience in claims management, ideally in life/health insurance or digital health in Asia.
• Sound knowledge of insurance regulations and digital health compliance requirements in Asia.
• Strong language capabilities especially in Cantonese, Mandarin, and English.

Responsibilities

• Manage and oversee a portfolio of complex claims ensuring prompt and accurate processing.
• Provide guidance and support to claims and customer service team members.
• Investigate and adjudicate claims including reviewing documentation and data analytics.
• Ensure compliance with company policies and industry regulations.
• Monitor and report on claims performance using KPIs and dashboards.

Skills

Analytical skills

Problem-solving skills

Communication skills

Negotiation skills

Interpersonal skills

Education

Bachelor's degree in business, finance, insurance, or health administration

Tools

Claims operating systems

Data analytics tools

Microsoft Office

Job description

Manage and oversee a portfolio of complex claims, ensuring prompt, accurate, and transparent processing in accordance with internal SLAs and regulatory standards.

Provide guidance, training, and support to claims and customer service team members; act as a Subject Matter Expert (SME) to resolve escalated cases and develop best practices.

Investigate, assess, and adjudicate claims, including review of documentation, data analytics, and digital health records, to determine eligibility, coverage, and liability.

Ensure strict compliance with company policies, industry regulations, and evolving digital health legislation in local and international markets.

Monitor, analyze, and report on claims performance using KPIs and dashboards; drive data-driven process improvement projects aiming for higher efficiency, automation, accuracy, and customer satisfaction.

Collaborate cross-functionally on system enhancements as well as solving customer enquiries.

Maintain accurate up-to-date claims databases and generate regular and ad hoc management reports for internal and regulatory review.

Proactively identify operational risks and recommend process or technology improvements.

Process Business as Usual (BAU) operational processes as well and any ad hoc tasks to improve company efficiency.

Qualifications

Bachelor's degree in business, finance, insurance, health administration, or a related field.

Minimum 2‑3 years experience in claims management, ideally in life/health insurance or a digital health in Asia.

Preferred experience with claims operating systems, workflow automation, and data analytics tools; proficiency in Microsoft Office and relevant claims management software.

Sound knowledge of insurance regulations, industry standards, and digital health compliance requirements in Asia.

Strong analytical, investigative, and problem‑solving skills with a keen eye for process optimization.

Excellent communication, negotiation, and interpersonal skills; able to engage diverse stakeholders and influence outcomes.

Self‑driven, results‑oriented, and comfortable working in fast‑growing, dynamic, and digital‑first environments.

Strong language capabilities especially in Cantonese, Mandarin, and English. Candidates proficient in Mandarin/Cantonese are preferred to effectively communicate with Mandarin/Cantonese‑speaking clients.