Our client is an insurance organisation seeking an experienced Medical Claims Officer to support its claims operations in Kuala Lumpur.
This opportunity focuses on the assessment and processing of individual medical claims, ensuring accurate claims decisions, timely settlements and a positive customer experience.
Key Responsibilities
- Assess and process inpatient and outpatient medical claims in accordance with policy terms, procedures and regulatory requirements.
- Review supporting documents, determine policy coverage and claim liabilities, and recommend settlements within delegated authority.
- Ensure claims are handled accurately and within agreed service standards and turnaround times.
- Maintain appropriate claims reserves and comply with internal governance and approval requirements.
- Identify and escalate complex, unusual or potentially fraudulent claims.
- Monitor claims trends and highlight operational issues, emerging risks and improvement opportunities.
- Prepare claims reports and support initiatives to enhance operational efficiency and customer experience.
- Collaborate with regional claims teams and internal stakeholders to maintain consistent claims handling practices.
Key Requirements
- Minimum 3 years of relevant experience in General Insurance, including hands-on inpatient and outpatient medical claims assessment.
- Good understanding of medical insurance coverage, claims adjudication, policy interpretation and medical terminology.
- Customer-focused, organised and able to meet service standards in a fast-paced environment.
- Good spoken English, Chinese and Cantonese.
- Proficiency in Microsoft Office and familiarity with claims management systems.
- Bachelor's degree in Insurance, Business Administration, Healthcare Management or a related discipline.
- ACII, ANZIIF or equivalent insurance qualifications would be advantageous.
Interested parties please send your resume to Valentina Zilinska, R1987165 at [email protected].
Regrettably, only shortlisted candidates will be contacted.
EA License Number: 20C0180 | Amethyst Partners | [email protected]