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
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