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Claims Process Manager

2 weeks ago

Petaling Jaya, Selangor, Malaysia Sperton Global AS Full time
Job Description

The Senior Claims Executive will be responsible for handling complex claims, mentoring junior staff, and supporting claims process improvements.

This role involves working closely with our management team to implement process improvements and develop streamlined claims workflows.

Additionally, the Senior Claims Executive will conduct periodic audits of claims to ensure compliance with industry regulations and internal standards.

This is an excellent opportunity for individuals who want to take their career to the next level and contribute to the growth and success of our organization.

Key Responsibilities

The key responsibilities of this role include:

  • Handling complex or high-value claims, providing in-depth analysis and investigation as necessary.
  • Reviewing and approving claims processed by junior staff, ensuring accuracy and adherence to company policies.
  • Mentoring and training junior Claims Executives on claims handling procedures and best practices.
  • Collaborating with management to implement process improvements and develop streamlined claims workflows.
  • Conducting periodic audits of claims to ensure compliance with industry regulations and internal standards.
  • Acting as a primary point of contact for escalated claims issues, working closely with healthcare providers, insurers, and clients to resolve disputes.
Requirements

To be successful in this role, you will need:

  • Diploma or bachelor's degree in healthcare, Business Administration, Finance, or related field.
  • Senior Claims Executive: 3-5 years of experience in healthcare claims processing, with exposure to complex claims management and team leadership.
  • Familiarity with healthcare claims systems and regulations is preferred.
Skills

To succeed in this role, you will need:

  • Strong attention to detail and accuracy in reviewing and processing claims.
  • Excellent communication skills, with the ability to handle sensitive healthcare and financial information confidentially.
  • Proficiency in MS Office Suite, especially Excel, for record-keeping and reporting.
  • Analytical thinking and problem-solving abilities, especially for handling complex claims (Senior role).
  • Ability to work effectively in a fast-paced environment, with strong time management skills.