Kerja Sepenuh Masa, Assistant Claims Manager di HMI Managed Healthcare Federal Territory - Maukerja

About the Role

We are seeking an experienced Claims Manager to lead our claims assessment team and oversee the end-to-end processing of patient claims. The successful candidate will ensure claims are processed accurately and efficiently in accordance with company policies, contractual requirements and service level agreements (SLAs).

This role is responsible for team performance, claims quality, technical support, reporting and continuous process improvement, while ensuring excellent service delivery to internal and external stakeholders.

Key Responsibilities

Claims Operations & Technical Oversight

• Oversee the processing of patient claims, ensuring accuracy, timeliness and compliance with company guidelines, contractual requirements and SLAs.
• Provide technical guidance to claims assessors and support the resolution of complex claims matters and inquiries.
• Monitor outstanding claims, payment cycles, billing issues and claims quality to ensure efficient processing and settlement.
• Review claims trends, identify potential risks and recommend appropriate actions in line with company policies.

Team Management & Performance

• Lead and manage onshore and offshore claims assessment teams, monitoring KPIs, productivity, turnaround time and service quality.
• Provide coaching and training to team members to improve technical capabilities, consistency and performance.
• Plan staffing requirements and allocate workloads to support operational efficiency and service delivery.
• Promote consistent application of claims guidelines, standard operating procedures and best practices.

Reporting, Compliance & Risk Management

• Prepare and present claims reports covering operational performance, significant claims events, financial reporting and data quality.
• Support the Head of Claims in reporting, data analysis and responding to internal and external stakeholder queries.
• Monitor chargeback expenses and prepare relevant reports for business units and clients.
• Coordinate internal and external claims audits, maintain accurate documentation and ensure incidents, errors and control issues are reported appropriately.
• Ensure team members understand and comply with applicable regulatory and compliance requirements.

Process Improvement & Stakeholder Management

• Review and update standard operating procedures and claims guidelines to maintain operational consistency.
• Identify opportunities to improve processes, productivity, service quality and claims handling standards.
• Participate in system enhancements, user acceptance testing and relevant operational projects.
• Work closely with internal stakeholders, third-party administrators (TPAs), investigators and other external parties to resolve claims-related issues.

Job Requirements

• Bachelor's Degree, Postgraduate Diploma or Professional Degree in any discipline. Insurance-related professional certifications will be an advantage.
• At least 6 years of working experience in claims handling, with at least 3 years in a team leadership or management role.
• Strong technical claims knowledge, analytical skills and sound judgement.
• Excellent communication and interpersonal skills, with the ability to engage effectively with internal and external stakeholders.
• Detail-oriented, well-organised and customer-focused.
• Able to work under pressure, manage competing priorities and identify practical solutions.