Specialist - Major Claims (Death & Critical Illness)

AIA; Sepang; On-site; MYR 48,000 - 72,000; Full time

Job summary

AIA is seeking ambitious individuals to join its Major Claims team in Malaysia. This role provides high-quality, timely Major Claims services (Death and Critical Illness) within delegated authority, in line with company policies, service benchmarks and risk standards.

Responsibilities include reviewing claims documents, assessing coverage and medical evidence, using digital systems and dashboards, and coordinating with Medical Advisors.

Qualifications

• Degree 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 is an added advantage.
• Strong English writing skills.

Responsibilities

• Review claims documentation, policy coverage, medical evidence, and loss details to determine claim validity and entitlement.
• Assess, review, investigate, approve and process Major Claims accurately and timely.
• Utilize digital claims systems, workflow tools and dashboards to monitor turnaround times and quality.
• Liaise with Medical Advisors for clinical guidance and informed decisions.
• Escalate complex or disputed claims with clear analysis and recommendations.
• Contribute to continuous process improvements in Major Claims workflows.

Skills

Strong English writing skills

Good communication

Self-motivated and customer-driven

Sound problem solving

Education

Biomedical/ Biology/ Medicine or related fields

Job description

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

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 escal… 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.