Health Claims Executive

7 days ago

Kuala Lumpur, Malaysia Techsap ASP Sdn Bhd Full time

**Job Summary**:

- To provide preferred claims experience in accordance with the service standard and procedure guideline set.
- Manage and settle legitimate claims.
- Provide prompt response to internal and external customers at all times.
- Participate and complete timely on the Projects assign.
- Adhere to all claim operating guidelines and regulations.
- All other and related job as stated in the job scope (which may be revised)

**Key Accountabilities**:
1. Claims Operations:

- Registration, processing and adjudication of claims within turnaround time including monitoring and follow-up on unsettled/outstanding claims promptly.
- Handle claims assigned independently or with little supervision and to ensure Company's interests are fully protected by minimizing the claim costs.
- Investigation on suspicious claims and finalized the claims on a timely basis in accordance with the agreed policies, processes and operational procedures.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments where necessary.
- To escalate grey area cases for medical bill vetting as per claims guidelines

2. Claims Costs:

- Verify policy liability and alert relevant teams eg underwriters, technical review on any suspicious, fraudulent claims.
- Assess & ensure all the claims process for cashless and reimbursement are accurate.
- Manage claims settlement costs and related claims expenses and ensure compliance with internal controls.

3. Claims Reserving:

- Reserves - ensures accuracy of reserve type use and adequacy of reserves for claims handled so that the Company’s liabilities are properly reported, and in compliance with Group & Internal reserving policies.
- File Reviews - ensure that claims assigned are reviewed regularly until closure and ensure fast disposal of valid claims.

4. Service Delivery & Customer Service:

- Response to Customers - always provide prompt response to internal and external customers inclusive of enquiries from regulatory authorities.
- Provide good customer claim experience within service delivery benchmark.
- Provide all kind of operational assistance & support for the Dept/Unit Lead

5. Projects, TPA Management & Reporting:

- Assist in projects initiatives to improve efficiency and productivity of the department/company.
- Assist in TPA Management/Outsourcing/Own provider management where/when required.
- Proactively address and / or escalate any operational issues and complaint to superior.

6. Claims Governance:

- Compliance - comply with the relevant requirements of the Insurance Act, 1996, Bank Negara Malaysia, PIAM, Company policies and procedures, Internal Audit requirements etc.

**Job Type**: Contract
Contract length: 12 months

Pay: Up to RM2,200.00 per month

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