Specialist-Claims (Corporate Solutions)

AIA Shared Services; Putrajaya; Vor Ort; MYR 60.000 - 90.000; Vollzeit

Zusammenfassung

AIA Shared Services in Malaysia is seeking an experienced Claims Assessor to process complex inpatient and outpatient claims for Group Policyholders. You will apply strong technical judgment, policy interpretation, and medical knowledge to ensure fair outcomes, identify fraud risks, and drive continuous improvement of claims processes.

You will analyze medical reports, invoices, and documentation to determine eligibility, maintain turnaround times, and communicate clearly with claimants and

Qualifikationen

• 3+ years of experience in handling minor medical claims.
• Strong technical knowledge of claims assessment and policy interpretation.
• Analytical mindset with ability to interpret data and identify fraud signals.

Aufgaben

• Independently assess complex claims by applying strong technical judgment, policy interpretation, and medical understanding to ensure fair and accurate claim outcomes.
• Leverage digital tools, rules engines, and available automation outputs to enhance assessment efficiency, while exercising human judgment for cases requiring interpretation, exceptions, or escalation.
• Analyze medical reports, invoices, and supporting documentation to validate claim eligibility, identify inconsistencies, and determine appropriate claim decisions in line with policy terms and exclusions.
• Ensure claims are processed within defined turnaround time (TAT), productivity, and quality benchmarks, balancing speed with accuracy and service excellence.
• Identify, investigate, and escalate potential fraud, abuse, or leakage risks, working closely with the Fraud Investigation Unit and relevant stakeholders to support effective risk mitigation.
• Manage claims requiring additional information by preparing clear, professional, and compliant correspondence to claimants, healthcare providers, and third parties, ensuring timely follow‑ups and resolution.
• Resolve payment discrepancies and suspense items through coordination with Finance, customers, and internal teams to ensure accurate and timely settlement.
• Provide technical guidance, coaching, and knowledge sharing to junior assessors, supporting consistent decision‑making, quality improvement, and team capability uplift.
• Identify opportunities for process improvement, simplification, and automation, contributing ideas and feedback to enhance claims accuracy, efficiency, and customer experience.
• Collaborate effectively with internal and external stakeholders (e.g. business partners, hospitals, service providers) to resolve escalations and support positive customer outcomes.
• Perform additional duties as required to support operational resilience, service continuity, and evolving business needs.

Kenntnisse

Claims assessment

Policy interpretation

Medical terminology

Fraud detection

Data analysis

Analytical thinking

Problem solving

Communication skills

Adaptability

Process improvement

Jobbeschreibung

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About The Role

To process complex inpatient and outpatient claims for Group Policyholders and apply strong technical judgment, digital tools, and data driven insights to ensure fair claim outcomes, effective risk and fraud identification, and continuous improvement of claims processes.

• Independently assess complex claims by applying strong technical judgment, policy interpretation, and medical understanding to ensure fair and accurate claim outcomes.
• Leverage digital tools, rules engines, and available automation outputs to enhance assessment efficiency, while exercising human judgment for cases requiring interpretation, exceptions, or escalation.
• Analyze medical reports, invoices, and supporting documentation to validate claim eligibility, identify inconsistencies, and determine appropriate claim decisions in line with policy terms and exclusions.
• Ensure claims are processed within defined turnaround time (TAT), productivity, and quality benchmarks, balancing speed with accuracy and service excellence.
• Identify, investigate, and escalare potential fraud, abuse, or leakage risks, working closely with the Fraud Investigation Unit and relevant stakeholders to support effective risk mitigation.
• Manage claims requiring additional information by preparing clear, professional, and compliant correspondence to claimants, healthcare providers, and third parties, ensuring timely follow‑ups and resolution.
• Resolve payment discrepancies and suspense items through coordination with Finance, customers, and internal teams to ensure accurate and timely settlement.
• Provide technical guidance, coaching, and knowledge sharing to junior assessors, supporting consistent decision‑making, quality improvement, and team capability uplift.
• Identify opportunities for process improvement, simplification, and automation, contributing ideas and feedback to enhance claims accuracy, efficiency, and customer experience.
• Collaborate effectively with internal and external stakeholders (e.g. business partners, hospitals, service providers) to resolve escalations and support positive customer outcomes.
• Perform additional duties as required to support operational resilience, service continuity, and evolving business needs.

Requirements

• Minimum 3 years of relevant experience in handling minor medical claims
• Strong technical knowledge of claims assessment, including policy interpretation, exclusions, medical terminology, and dispute resolution, with consistent application of judgment and controls.
• Analytical mindset with the ability to interpret data, trends, and exception indicators, including fraud flags, anomaly alerts, and quality findings to support sound, risk‑based decision‑making.
• Strong problem‑solving and critical‑thinking skills, particularly in handling exceptions, escalations and non‑straight‑through processing cases.
• High level of attention to detail and follow‑through, ensuring completeness, accuracy, and timely closure of claims and related correspondence.
• Effective communication skills, both written and verbal, with the ability to explain claim decisions clearly and professionally to internal and external stakeholders through digital channels.
• Willingness and ability to adapt to change, including adoption of new systems, automation, analytics tools, and evolving claims practices.
• Demonstrate commitment to continuous learning, skill development and participation in process improvement initiatives.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.