Medical Claims Executive

2 weeks ago


Kuala Lumpur, Malaysia Hunters International Sdn Bhd Full time

**About the Company**

Our client is a global health service company dedicated to helping people improve their health, wellbeing and peace of mind. They have over 74,000 employees who serve more than 170 million customers throughout the world. They deliver choice, predictability, affordability and access to quality care through connected, personalised solutions that advance whole person health, both in body and mind.

**Responsibilities**:

- Processes claims from members and providers.
- Maintains files for authorizations and other reports.
- Assesses and processes claims in line with the policy coverage and medical necessity.
- Be fully versed with medical insurance policies for various groups / beneficiaries.
- May assist in training colleagues and asked to share knowledge.
- Accurately assesses eligibility within the policy boundaries.
- Monitors and maintains the claims processing as per the defined terms and policy of the organization.
- Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis.
- Monitors the qualitative and quantitative measures for claims & pre-approvals.
- Ensures compliance to any changes in terms of system parameters or process.
- Maintains quality as per framework for accuracy.
- Maintains productivity and responsiveness to the work allocated.
- Collaborate with other stakeholders / teams to resolve queries including complex queries.
- Actively support all team members to enable operational goals to be achieved.
- Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).
- Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.
- Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods.
- Following up own workload (volume and timing): keeping an eye on chronology and processing time of the work volume and taking suitable actions.
- Participate efficiently in processing the flow of claims: inform the supervisor about claims lacking clarity and about possible ways of optimizing the processes.
- A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactions are important motivators.
- Monitor and highlight high-cost claims and ensure relevant parties are aware.
- Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication.
- Adjust error claims according to actual situation.
- Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly.
- Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved

**Job Requirements**
- At least 1-2 years of experience performing a similar role.
- **Fluency in written & spoken Mandarin & English, is a must.**:

- Experience of working for an international company, preferred but not essential.
- Claims processing or insurance experience, preferred but not essential.
- Broad awareness of medical terminology, advantageous.
- Excellent organizational skills, capable of following and contributing to agreed procedure.
- Strong administration awareness and experience, essential.
- First class written and verbal communication skills, essential.
- Ability to communicate across a diverse population, essential.
- Capable of working independently, or as part of a team.
- Good time management, ability to work to tight deadlines.
- Flexible and adaptable approach, sometimes working in a fast-paced environment.
- Passion for achieving agreed objectives.
- Confident in calling out when facing issues.
- Should be flexible to work in shifts and on staggered weekends.

**Remuneration**
- RM 3,600 - RM 3,800
- Fixed Allowance
- Language Allowance

**Job Types**: Full-time, Permanent

**Salary**: RM3,600.00 - RM3,800.00 per month

**Benefits**:

- Health insurance
- Professional development

Schedule:

- Monday to Friday

Supplemental pay types:

- Overtime pay

Ability to commute/relocate:

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

Application Question(s):

- Are you flexible to work in shifts and on staggered weekends?

**Experience**:

- medical claims: 1 year (required)

**Language**:

- Mandarin (required)



  • Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    This role is for a dedicated individual who will handle medical claims with precision and attention to detail. As a Claims Executive at Pra Assist Medical Network Sdn Bhd, you will be responsible for processing medical claims, liaising with healthcare providers, reviewing and verifying claim submissions, and maintaining insurance policy information.Key...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    Job OverviewThis role involves the processing of medical claims and payments, ensuring efficient and accurate communication with healthcare providers. A key responsibility is to maintain comprehensive insurance information.This job may be ideal for individuals who enjoy reviewing claims, determining coverage, and processing payments efficiently.

  • Claims Executive

    6 days ago


    Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    This job is for a Claims Executive. You will process medical claims, liaise with healthcare providers, review and verify claim submissions, and record policy information. You might like this job because it involves data processing, communication, and problem-solving.RM 2600 - RM 5000Full-TimeJob DescriptionData processing of medical claims and claims...

  • Claims Executive

    2 days ago


    Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    This job is processing medical claims and payments, liaising with healthcare providers, and maintaining insurance info. You might like this job because it involves reviewing claims, determining coverage, and processing payments efficiently.RM 2700 - RM 5000Full-TimeJob DescriptionData processing of medical claims and claims paymentsTo liaise with panel...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    We are looking for an experienced Claims Executive to join our team at Pra Assist Medical Network Sdn Bhd. The ideal candidate will have a proven track record of handling medical claims efficiently and effectively, with a keen eye for detail and excellent communication skills.In this role, you will be responsible for processing medical claims, communicating...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Cigna Full time

    Cigna Global Health Benefits is an integral part of Cigna's growing international businesses. Product types include Medical, Dental, Vision, Life, AD&D, Disability, Travel, etc., sold to groups and individuals.We have approximately 1 million medical members worldwide. As a Claims Representative, you will be responsible for ensuring that claims are accurately...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    Pra Assist Medical Network Sdn Bhd is seeking a highly skilled and organized Claims Executive to join our team. As a key member of our team, you will be responsible for managing medical claims, ensuring accurate and timely processing, and maintaining excellent relationships with healthcare providers.Your primary duties will include data entry and management,...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Cigna Full time

    Cigna Global Health Benefits is a leading provider of health care and expatriate employee benefits. Our company operates in countries across the Americas, Europe, Africa, and Asia Pacific.We have approximately 1 million medical members worldwide.Our ideal candidate will possess strong analytical skills and be able to critically evaluate claims for medical...


  • Kuala Lumpur, Malaysia AIA Full time

    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...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Pra Assist Medical Network Sdn Bhd Full time

    Key ResponsibilitiesAs a Healthcare Administrative Coordinator, your primary duties will include:Data processing of medical claims and claims payments.Liaising with panel healthcare providers on necessary documentation.Reviewing claim submissions and verifying the information.Recording and maintaining insurance policy and claims information in a database...

  • Claims Executive

    2 weeks ago


    Kuala Lumpur, Malaysia SynergyHR Sdn Bhd Full time

    **YOUR ROLE** - Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. - Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods. - Following up his/her own workload (volume and timing): keeping an eye on chronology...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Prudential Hong Kong Limited Full time

    The Manager, Medical Claims Strategy and Operations is responsible for Medical Claims Fraud, Waste and Abuse (FWA) detection and Claims Avoidance Rate in Prudential to ensure long-term sustainability of the portfolio. This role requires strong knowledge in medical and insurance processes, as well as excellent leadership and communication...

  • Executive, Claim

    2 weeks ago


    Kuala Lumpur, Malaysia Prudential plc Full time

    Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support...


  • Kuala Lumpur, Malaysia Prudential Full time

    Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career...


  • Kuala Lumpur, Kuala Lumpur, Malaysia gradmalaysia Full time

    Job OverviewThe role of Individual Claims Management, Analyst is critical in ensuring the integrity of our claims process. You will assess and settle individual health insurance claims arising from policies in force, while maintaining excellent communication with stakeholders.Develop and implement effective claim assessment strategies to improve efficiency...


  • Kuala Lumpur, Malaysia Chrisjac Recruitment Services Full time

    **Position: Insurance Claims Executive.**: - **Salary: RM 4000-5000.**: - **Job location: City center (5-day week), Kuala Lumpur.** Chrisjac is currently seeking individuals who are interested in Executive Claims administration position for an established insurance company in Kuala Lumpur. This position would be based at their Motor Claims Department...


  • Kuala Lumpur, Malaysia Chrisjac Recruitment Services Full time

    **Position: Insurance Claims Executive.**: - **Salary: RM 4000-5000.**: - **Job location: City center (5-day week), Kuala Lumpur.** Chrisjac is currently seeking individuals who are interested in Executive Claims administration position for an established insurance company in Kuala Lumpur. This position would be based at their Legal Department responsible...


  • Kuala Lumpur, Kuala Lumpur, Malaysia Comcorde Medical (M) Sdn Bhd Full time

    Sales and Business DevelopmentWe are seeking a highly motivated and results-driven sales professional to join our team as a Medical Device Sales Representative.In this role, you will be responsible for developing and executing sales strategies to achieve business objectives.Key responsibilities include:Developing and maintaining strong relationships with...


  • Kuala Lumpur, Malaysia HiredSearch Full time

    Process pre-approval requests in accordance with required benchmarks - Evaluate and gather all data for claim / underwriting processes, prepare medical questionnaire and to review all status and ensure efficient adjustment in claim / underwriting system - Ensure meeting individual quality, turnaround time and productivity benchmark - Effective assessment of...


  • Kuala Lumpur, Malaysia Agensi Pekerjaan Hiredsearch Services Sdn Bhd Full time

    Process all Life and/or Accident & Hospitalization claims requests received as per stipulated requirements - Process pre-approval requests in accordance with required benchmarks - Evaluate and gather all data for claim processes, prepare medical questionnaire and to review all status and ensure efficient adjustment in claim / underwriting system - Ensure...