The Assistant Manager, Claims (Lead, Accident & Health) is responsible for leading and overseeing the Accident & Health claims function (including Medical, Dental, Personal Accident, and Travel claims) ensuring efficient, accurate, and compliant end-to-end claims handling. This role involves managing complex and high-value claims, providing strategic direction, and driving operational excellence across the team. The Manager ensures adherence to company policies and Bank Negara Malaysia regulations while delivering high standards of customer service and claims outcomes. The ideal candidate demonstrates strong leadership, technical expertise, and the ability to optimize processes and team performance.
Job Requirements
- Lead and oversee the end-to-end management of Accident & Health claims (Medical, Dental, Personal Accident, and Travel) insurance claims from notification through to settlement.
- Review, approve, and provide direction on complex, high-value, and escalated claims cases, including complaints, disputes and litigation case.
- Supervise and manage team members, ensuring productivity, quality, and consistency of liability and claims quantum assessment in accordance with policy terms and guidelines.
- Monitor claims performance metrics including turnaround time (TAT), reserve adequacy, and claims trends.
- Build and maintain strong relationships with third-party administrators (TPAs) as well as agents, brokers, and other stakeholders to ensure timely assessments and smooth claims handling.
- Collaborate with internal stakeholders including branches, underwriting, IT, and marketing teams to resolve claims-related issues effectively
- Identify and escalate deficiencies in policy coverage and adverse claims trends to Senior Management for corrective action.
- Drive claims strategy to optimize cost control, minimize leakage, and improve claims outcomes
- Lead reporting and provide insights on claims analytics, trends, and operational performance to senior management.
- Ensure compliance with internal governance, audit requirements, and Bank Negara Malaysia regulations
- Drive continuous improvement initiatives, including process enhancements, automation, and service delivery improvements.
- Support strategic initiatives, including system enhancements and portfolio performance reviews.
