Senior Manager, Individual Benefit Cashless Claim

Build a healthier and more sustainable future for everyone.

About the Role

Lead and manage the end-to-end Cashless Medical Claims and Guarantee Letter (GL) operations for Individual Business (IB), including Additional Guarantee requests for both IB and Employee Benefits (EB) portfolios.

Support Health Operations Project managements

Ensure timely, accurate and compliant claim decisions, strong stakeholder collaboration, operational efficiency, and excellent customer experience.

Roles and Responsibilities:

• Manage daily Cashless Medical Claims and GL operations for IB and Additional Guarantee requests for IB & EB portfolios.
• Ensure cases are assessed accurately and completed within established TATs and service standards.
• Monitor productivity, inventory, backlog, ageing cases and case clearance.
• Handle complex, urgent and escalated cases while ensuring appropriate resolution.
• Lead, coach and develop Team Leaders and staff to achieve operational and service objectives.
• Drive performance management, workforce planning and capability development.
• Manage key stakeholders including Contact Centre, Branches, Customer Service, Technology, Takaful, Underwriting, Claims, Medical Management and other business units.
• Collaborate with panel hospitals and healthcare providers to ensure smooth cashless admission services.
• Manage customer, agent, provider and management escalations, ensuring timely resolution.
• Ensure compliance with operational guidelines, governance requirements, policies and regulatory standards.
• Drive process improvements, automation initiatives and operational excellence projects.
• Prepare and present operational performance reports, service metrics and management updates.

Minimum Job Requirements:

• Degree in Insurance, Healthcare, Business Administration or related field.
• Minimum 8 years of experience in medical claims, cashless operations or healthcare administration.
• Minimum 3 years of leadership experience managing operational teams.
• Strong knowledge of medical claims assessment, Guarantee Letter operations, healthcare providers and insurance operations.
• Strong stakeholder management, problem-solving and decision-making skills.
• Experience managing escalations, service delivery and operational improvement initiatives.