Position Objective
To ensure the effective administration of Major Claims in alignment with departmental goals and corporate strategy.
Roles and Responsibilities:
Claims Processing
- Assess and settle both incontestable and contestable major claims (e.g., Critical Illness, Total and Permanent Disability, Dismemberment, Death) within the stipulated turnaround time (TAT), adhering to internal procedures and regulatory guidelines.
- Manage pending cases monthly to achieve the targeted reduction in pending ratios.
- Monitor closed file reviews to ensure timely provision reversals and contribute to OPAT savings.
Productivity
- Meet daily claims productivity benchmarks within authority limits, ensuring high accuracy and efficiency.
Enquiry Management
- Respond to stakeholder enquiries (calls/emails) within 2 working days, maintaining professional and timely communication.
Suspense Case Management
- Clear suspense cases within 5 days from the date of email receipt.
Other Duties
- Undertake additional responsibilities, special projects, and assignments as directed by the supervisor to support operational needs.
Minimum Job Requirements
- Education: Bachelor's Degree in a relevant field.
- Experience: 15 years of experience in claims processing or a related function.
- Independent and proactive work ethic.
- Strong customer service orientation with a positive attitude.
- Excellent interpersonal and communication skills (verbal and written) in both English and Malay.
- Sound knowledge of claims assessment, FSA 2013, and relevant technical competencies.
