Team Lead - Claims Assessor (Singapore Inpatient/Outpatient Claims)

Integrated Health Plans; Kuala Lumpur; On-site; MYR 50,000 - 70,000; Full time

Job summary

A health insurance provider is seeking a Team Lead for Claims Assessors in Kuala Lumpur. The role involves overseeing the team responsible for processing inpatient and outpatient claims, ensuring accuracy and compliance with policies. The ideal candidate must have a diploma, strong knowledge of health insurance policies, and at least 1 year of experience in claims management. Strong leadership and analytical skills are essential for driving operational excellence and managing team performance.

Qualifications

• At least 1 years’ experience in medical claim management.
• Strong knowledge of health insurance policies and claims processes.
• Versatile and adaptable to fast-changing environments.

Responsibilities

• Lead and manage a team of claims assessors.
• Oversee daily operations for timely claim assessment.
• Monitor team performance through KPIs and quality metrics.
• Provide guidance on complex claims and escalated issues.
• Conduct quality audits of claims decisions and documentation.

Skills

Leadership skills

Analytical skills

Communication skills

Problem-solving skills

Knowledge of health insurance policies

Education

Diploma or higher educational qualification

Job description

Team Lead - Claims Assessor (Singapore Inpatient/Outpatient Claims)

As the Team Leader, you will oversee daily operations and guide a team of claim assessors in processing inpatient and outpatient medical claims, ensuring accuracy, efficiency, and full adherence to policy requirements and regulatory standards.

Key Responsibilities

Lead and manage a team of claims assessors responsible for processing inpatient and outpatient medical claims, ensuring accuracy, efficiency, and adherence to policy terms and internal guidelines.

Oversee daily operations to ensure timely assessment of claims in line with service level agreements (SLAs) and quality standards.

Provide guidance and support to team members on complex claims, escalated issues, and policy interpretations to ensure fair and consistent outcomes.

Review and approve high-value or non-standard claims, ensuring appropriate documentation and justification.

Monitor team performance through KPIs and quality metrics, addressing gaps through coaching, training, and performance management.

Collaborate with cross-functional teams including policy administration and customer service to resolve issues and drive operational improvements.

Identify potential fraud, waste, or abuse in claims and coordinate with the appropriate internal teams for further investigation.

Support continuous improvement initiatives by analyzing trends, identifying root causes of issues, and recommending process enhancements.

Conduct quality audits of claims decisions and documentation to ensure compliance with internal policies and regulatory requirements.

Prepare reports and updates for management, providing insights into team performance, claim trends, and operational risks.

Key Requirements:

Diploma or higher educational qualification.

Strong knowledge of health insurance policies and claims processes.

At least 1 years’ experience in medical claim management with direct reporting agents.

Commitment in driving process improvements and achieving operational excellence.

Strong leadership skills with the ability to provide technical guidance and motivate teams to achieve their best performance.

Good analytical and problem-solving abilities.

Good communication skills, both verbal and written, with the ability to interact with stakeholders at all levels.

Versatile and adaptable to fast-changing environments

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