Claims Manager

4 days ago


Kuala Lumpur, Malaysia CompuMed Services Sdn Bhd Full time

Job Description

JOB SCOPE (Major Responsibilities of this job)
- Have full understanding of the company’s claims management system (major and medical claims) and be able to constantly work on improving the claims management system
- Have full comprehension of the client’s needs in regard to the claims management.
- Review provisions of certificate or policy to determine the patient’s included medical coverage losses.
- Ensure the compliance of service level in claims submission.
- Ensure the work processes comply with the Quality Management System & ISO.
- To support the sales presentation to potential clients on the functions and services of the department.
- Attend to all queries and complaints from client, hospital and service provider.
- To provide training to the hospital personnel on the Company’s workflow for admission and claim submission.
- To provide claims review to insurance clients and corporate clients.
- Responsible to provide necessary insurance, policy wording, claim process, reporting formats training beside other self-improvement briefings and training for the claims department on a periodic basis to ensure positive employee relations and in line with company goals.
- Responsible to arrange and provide claims information training to Claims Department.
- To provide commercial analysis, planning, monitoring including prepare reports for management on a timely manner.
- Responsible for preparations of sales presentation to potential clients on the functions and services of the Claims Department.
- Responsible to meet, hold discussion and provide service to clients including update the clients on the new developments of the claim procedures.
- To assist Head of Call Centre or Operations Manager with the provision of medical opinions and medical approval of cases to insurance clients or corporate clients on a case-to-case basis as when the need arises
- Ensure all claims information remains confidential.

JOB SPECIFICATION
- Job holder must have at least bachelor’s degree in relevant working experience in TPA, Healthcare or Insurance industry
- Experience of administration procedures within an insurance environment, service provider or health organization is also beneficial
- At least 3 year(s) of working experience in the related field is required for this position
- High level of work commitment and strong sense of responsibility
- Good spoken and written communication skills in Bahasa Malaysia & English
- Computer Literate
- Working experience in TPA, insurance or healthcare industry

**Salary**: RM4,600.00 - RM6,800.00 per month

**Benefits**:

- Health insurance
- Maternity leave
- Professional development

Schedule:

- Monday to Friday

COVID-19 considerations:
completed 2 doses for covid-19 vaccine

Ability to commute/relocate:

- Kuala Lumpur: Reliably commute or planning to relocate before starting work (required)


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