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Claims Investigation Executive

1 month ago

Malaysia Allianz Popular SL. Full time

Process health claims, identify potential abuses, and ensure strategic initiatives align with company goals, focusing on risk mitigation and fraud prevention.

Key Responsibilities:

  • Assess health claims, particularly in investigation cases, and identify potential abuses or suspected fraud.
  • Develop strategies to gather evidence for non-disclosures or pre-existing conditions.
  • Meet targets for cost avoidance and review outstanding investigation claims.
  • Liaise with customers, agents, and doctors to facilitate claim settlements.
  • Ensure claims are processed within specified turnaround time and draft correspondence independently.

Requirements for Success:

  • Graduate in bio-medical science or related field (added advantage).
  • 2 years of experience in health claims (added advantage).
  • Knowledge of medical terms or medical-related studies (added advantage).
  • Experience in claims investigation.
  • Good communication skills in written and verbal formats.
  • Ability to think outside the box.

Customer Services & Claims | Professional | Allianz Malaysia | Full-Time | Permanent