Kerja Sepenuh Masa, Senior Executive, Claims (Family) di Takaful Malaysia Federal Territory - Maukerja

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