Kerja Sepenuh Masa, Senior Claims Examiner, A-H Claims di Chubb Federal Territory - Maukerja

Job Description

Key Objective

The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.

Key Accountabilities & Responsibilities

• Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis.
• Auditing cashless claims for Group and Individual hospitalisation and surgical claims.
• Overseeing and facilitating payment processing for bordereaux medical claims.
• Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements.
• To monitor the performance of the appointed TPA and be proactive on liaising with TPA on resolving issues.
• Keeping constant communication with management and underwriting teams.
• Providing feedback on any visible claims trends.
• Monthly/Quarterly/Yearly review of aging files.
• Participate in Ad Hoc projects or tasks as assigned by supervisors.
  
  

Qualifications

• Experience in handling medical related claims.
• Have sound knowledge on both medical and claims practices.
• Able to read and interpret medical reports.
• Strong attention to detail and accuracy in data entry, and document management.
• Critical thinking in evaluating authenticity of claims.
• Familiarity with Microsoft Office Suite (Word, Excel, Outlook).
• Effective communication skills, both written and verbal.
• Proactive and have strong work ethics.
• Willingness to learn and adapting to new processes and regulatory requirements.
• Ability to work collaboratively in a team environment and support multiple tasks.
• Professional attitude and discretion when handling confidential information.