Senior Executive, Claims (Family)
Senior Executive, Claims (Family)
Takaful Malaysia3-5 Years
- Posted 15 hours ago
- Be among the first 10 applicants
Job Description
This role will manage the end-to-end processing and administration of Individual Family Claims while ensuring adherence to regulatory and operational requirements, established guidelines, and agreed service level efficiencies with business partners.
Efficiency of claims services
- To ensure end to end claims administration, inclusive of claims registration, claims adjudication/ assessment (approval, rejection or deferment), claims payment within stipulated service level agreement
TPA Monitoring
- To monitor incoming and accuracy data from TPA
- To provide feedback & obtain input to/ from TPA whenever to ensure maximum service deliverable for both parties
Improve Functional Service
- To improve existing processing flow and maintenance of SOPs and claims guidelines from time to time to reflect the latest practise of claims
- To prepare monthly, and any ad-hoc report, & deliver within agreed timeline
- Actively involved in system enhancements, migration or any projects/ UAT testing and deliver within stipulated timeline
- Provide/ share concrete suggestion or feedbacks base on industry practise to achieve optimum service to claimant
Strategic Risk Management
- Assessing and managing risk, if any throughout all aspects of the process/ initiatives/ projects implementation
- Develop a solution/ strategy to overcome and address the identified risk
- Support an ethical culture to fulfil legal and compliance requirement, and encourage professionalism amongst stakeholders
Qualification
- Degree in insurance industry or equivalent academic achievement
- Minimum 3 to 5 years related experience in handling medical claims assessment
- Knowledge of insurance industry or specifically nursing/ medical knowledge is preferable
- Good knowledge in Medical Insurance principle and Individual product/policy
- Ability to organize and prioritize multiple tasks and meet deadlines
- Ability to work independently and as a team player
- Good interpersonal and communications skills
- Good analytical and problem solving skills
More Info
Key Skills
Claims registration
Claims assessment
Claims adjudication
Claims payment
TPA monitoring
About Company
Skills:
Microsoft Excel, Internal Audit, Compliance, SAP ERP systems, Data analytics tools, Finance, Governance, Risk Management, Project Controls
Skills:
Quality Control, Regulatory Compliance, Data Analysis, Iso 9001, Iso 14001, Process Improvement, Contract Management, ERP Systems, Microsoft Office Suite, Risk Mitigation
Skills:
Risk Management, Property Risk Survey, Electronics Engineering, Process Safety
Skills:
Data Analysis, Risk Analysis, audit program development, insurance industry concepts, audit methodology, project management, audit testing
Skills:
Trade Operations Management, Risk Regulatory Management, Project management, Knowledge of market trends and current developments related to Trade Finance, Operations Management, Knowledge of ICC rules governing International Trade