Associate, Group B40 Claims

2 weeks ago

Kuala Lumpur, Kuala Lumpur, Malaysia Great Eastern Full time

About the Job

A Claims Assessor is responsible in assessing Hospitalization Benefit and Critical Illness claims, ensuring accuracy and adherence to company policies. This entry-level role provides an excellent opportunity for individuals looking to develop a career in claims management.

Key responsibilities:

  • Review and assess Hospitalisation and Critical Illness claims documentation to ensure completeness and accuracy, determine the validity of claims and ensure they are processed in a timely manner.
  • Liaise with policyholders and third parties to gather necessary information for claim resolution.
  • Follow up on outstanding information and documentation for claims processing, maintain accurate records of claims activities and ensure proper documentation is filed.
  • Support senior team members in handling complex claims or escalations.
  • Adhere to company guidelines and regulatory requirements in all claim assessments.
  • Provide feedback & guidance to the service provider / Third Party Administrator (TPA) to improve quality performance. Ensure TPA compliance with SLAs, including TAT, Quality and productivity targets.
  • Prepare and monitor relevant reports to ensure smooth claims lifecycle.
  • Prepare and conduct training for Claims team to close the gap in knowledge and improve quality assessment skills.

We are looking for people who

  • Has a formal degree or higher qualification, preferably in insurance, science, biomedical science, or a medical field; additional medical certification is a plus.
  • Has 0-2 years of experience in claims handling or customer service related.
  • Has a willingness to learn and develop knowledge of claims processes and industry regulations.
  • Has strong attention to detail and organizational skills.
  • Has ability to work effectively within a team environment.
  • Key Competencies: results-driven with strong communication and interpersonal skills; ability to work under pressure, stay focused, and pay attention to detail; strong problem-solving and analytical skills; strong communication skills and the ability to handle multiple tasks simultaneously.
  • Key Knowledge: proficient in Microsoft Office (Word, PowerPoint, Excel) and IT literate; knowledge of Takaful/Insurance regulations and legal requirements, claims processing, and data analysis; strong strategic thinking and job-specific knowledge.

To All Recruitment Agencies

Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or our employees. We will not be responsible for any fees related to unsolicited resumes.

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