Specialist/Senior Executive, Claims (Life Insurance)

Generali; Kuala Lumpur; On-site; MYR 60,000 - 80,000; Full time

Job summary

A leading life insurance company in Kuala Lumpur is seeking a Specialist/Senior Executive for Claims. This role involves providing exceptional customer service, managing claims efficiently, and ensuring compliance with industry regulations. Ideal candidates will have a bachelor's degree and at least 5 years of claims handling experience. Strong analytical and problem-solving skills are necessary. Join us to make a difference in our service delivery and optimize business processes.

Qualifications

• Bachelor's degree in any related field.
• Minimum of 5 years of experience in claims handling, preferably within the insurance industry.

Responsibilities

• Assess and approve major claims within the defined approval authority limit.
• Identify improvement opportunities based on data insights.
• Review pending claims and appeals and make appropriate revised decisions.
• Liaise with Doctors and other Insurers to determine validity of claims.
• Investigate suspicious claims and make recommendations.

Skills

Analytical skills

Critical thinking

Problem-solving skills

Multi-tasking

Prioritization skills

Education

Bachelor's degree in a related field

Job description

Specialist/Senior Executive, Claims (Life Insurance)

Providing reliable and responsive customer service and claims advice to all our policyholders and agents. The service will include handling claims enquiries, complaints, processing and case management.

Responsibilities:

1. Operational Efficiency

Assessment and approval of Major Claims, Medical and PA claims within the defined approval authority limit set and committed service level.

To make recommendations for cases above limit to Superior for their approval.

2. Simplification

Being proactive in identifying improvement / enhancement opportunities based on data insights and being active in seeking and sharing ideas for innovation in business processes.

3. Customer Service

Review pending claims and appeals within the committed service level and make an appropriate revised decision if it is within the authority limit.

Handle enquiries and provide quality customer service to clients and agents

4. Control & Functions

Adherence to Financial Services Act 2013, AMLA, Standard Operating Procedures (SOP), Bank Negara Malaysia guidelines and Group Standard Procedures.

Liaison with Consultant Doctor and other Insurers to determine validity and liability of the Company.

Initiate and conduct investigation on suspicious claim and make recommendations to the immediate superior.

5. Individual Development

To leverage trends and relationship to provide high-quality customer service.

Ability to gather unique perspectives from other teams / functions to optimize outcomes.

Requirements:

1. Education: Bachelor's degree in any related field.

2. Experience: Minimum of 5 years of experience in claims handling, preferably within the insurance industry.

3. Skills:

Strong analytical, critical thinking and problem-solving skills.

Strong multi-tasking and prioritization skills.