Specialist - Major Claims (Death & Critical Illness)

AIA; Malaysia; Vor Ort; MYR 60.000 - 90.000; Vollzeit

Zusammenfassung

AIA Hong Kong and Macau is seeking an experienced Major Claims professional for the Malaysia-based role. You will review and assess major life claims (Death, Critical Illness, TPD), determine liability, and ensure timely, accurate payment decisions using digital claims systems.

The ideal candidate has at least 2 years in Major Claims, strong English writing and communication skills, and a proactive, customer-focused mindset.

Qualifikationen

• Education in Biomedical/Biology/Medicine/Nursing or related field.
• Minimum 2 years Major Claims experience (death/CI/TPD).
• Strong English writing and good communication skills.
• Self-motivated and customer-driven; strong problem solving.

Aufgaben

• Provide high-quality Major Claims services (Death and Critical Illness) within authority and guidelines.
• Review claims docs, policy coverage, medical evidence, and facts to determine validity and entitlement.
• Assess, review, investigate, approve and process Major Claims accurately and timely.
• Utilize digital claims systems, workflow tools, and data dashboards to monitor turnaround and quality benchmarks.
• Leverage automation and AI-enabled tools to enhance efficiency and accuracy.
• Liaise with Medical Advisors for guidance and supported decisions.
• Manage suspense, follow up on requirements, ensure timely claim payments.
• Suggest process improvements and participate in innovation initiatives.

Kenntnisse

English writing

Communication

Customer-driven

Problem solving

Ausbildung

Biomedical/Biology/Medicine/Nursing related

Tools

Digital claims systems

Workflow tools

Data dashboards

Jobbeschreibung

About the Role

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.

• Provides high-quality, timely, and accurate Major Claims services (Death and Critical Illness) within delegated authority, in line with Company policies, service benchmarks and risk standards.
• Review claims documentation, policy coverage, medical evidence, and loss details to determine claim validity, liability, and entitlement in accordance with Company guidelines and delegated authority.
• Assess, review, investigate, approve and process Major Claims (Death and Critical Illness) accurately and timely, applying sound technical judgment and appropriate risk controls.
• Utilize digital claims systems, workflow tools, and data dashboards to manage claim assessments, monitor turnaround time and ensure adherence to service level and quality benchmarks.
• Leverage available automation and AI-enabled tools to enhance assessment efficiency, consistency, and accuracy.
• Liaise with Medical Advisors to obtain clinical guidance and clarification where required, ensuring informed and well supported claim decisions.
• Perform effective suspense management, follow up on outstanding requirements, and liaise with Finance and relevant stakeholders to ensure timely and accurate claim payments.
• Actively discuss, document, and elevate complex or disputed claims to senior assessors or management for guidance and resolution, supported by clear analysis and recommendations.
• Contribute to continuous process improvement initiatives by identifying operational inefficiencies, recurring issues, and improvement opportunities within Major Claims workflows.
• Participate in innovation initiatives (e.g. system enhancements, pilot tools, process simplification), providing user feedback and supporting adoption at the operational level.
• Support knowledge sharing and capability building within the team by sharing best practices, lessons learned and updates on process or system changes.
• Perform other tasks and responsibilities as assigned to meet operational requirements and evolving business needs.

Requirements

• Education qualification in Biomedical, Biology, Medicine, Nursing or related fields
• Minimum 2 years Major Claims experience (death, critical illness and/or total permanent disability)
• Experience in Life insurance will be an added advantage
• Strong English writing skills.
• Good communication skill.
• Self-motivated and customer-driven
• Sound problem solving skill

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

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

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. As the largest listed company on the Hong Kong Stock Exchange, we’ve been proudly making a difference for people and communities across Asia for over a century. And we build on this every day with our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030. If you work at AIA, you play an important part in this movement. Which is why we give you every opportunity to learn, grow and shape your career - your way. Inspiring and supporting you to thrive - not just at work, but in life. Believe in better with AIA. View our AIA LinkedIn page Bring your difference to AIA