Manager, Claims Processing (RSC)

Great Eastern Lihat semua pekerjaan

  • Kuala Lumpur
  • Tetap
  • Sepenuh masa
  • 2 hari lepas
We are looking for an experienced Claims Manager (Processing) to handle and deliver end to end assessment and processing of Life & Health claims within the Regional Service Centre, ensuring accurate, timely, and compliant claims outcomes in accordance with delegated authority limit, service standards, and established procedures. You’ll play a vital role in ensuring our policyholders receive timely and accurate support when they need it most. You will also be given the opportunity to participate in continuous process improvement initiatives, enhancing overall claims experience.1. Claims Processing & Decision Making
  • Assess and process Life & Health claims within delegated authority limit and established service standards, ensuring compliance with policy terms, claims guidelines, and SOPs.
  • Ensure accurate benefit determination, correct payee details, reserve adequacy and timely claim settlement.
  • Conduct review of pending claim to ensure closure of claims in a timely manner.
  • Identify claim patterns and unusual or inappropriate practices and recommend improvements to strengthen claims controls and streamline claim processes.
  • Identify and resolve processing issues, escalating out of scope complexity appropriately.
  • Mentor and guide junior claim assessors.
2. Stakeholder & Customer Engagement
  • Engage with medical professionals, policyholders, claimants and agents to obtain necessary documentation, clarify information or outstanding requirements for claim evaluation.
Provide timely updates and operational insights to internal stakeholders.
  • Delivery of Service Excellence
  • Provide clear, empathetic communication timely to policyholders, claimants and agents medical professionals, and internal stakeholders, making the claims process smooth and transparent.
  • Process Standardization & Improvement
  • Ensure standardization of claims processing workflows across markets supported by the Regional Shared Centre.
  • Identify opportunities to simplify processes, improve straight through processing, and enhance efficiency.
  • Ensure Governance, Risk & Compliance
  • Adhere to internal policies and external regulatory requirements to maintain integrity and trust in our claims operations.
Maintain strong operational controls to mitigate processing, financial, and compliance risks.Proactively identify operational and compliance risk areas and implement corrective actions.
  • Support audits, quality assurance, and compliance reviews as required.
  • Maintain proper documentation and audit trail for claims decisions.
Qualifications
  • Holds a Bachelor’s degree or Professional Insurance Certificate or a related insurance or healthcare discipline.
  • 6–10 years of life and/or health insurance claims experience, with strong hands-on exposure to claims processing.
  • Strong grasp of medical practices, terminology, ICD/CPT codes, and insurance policy terms
  • Strong analytical skills with ability to interpret complex medical data, spot trends, and make sound decisions under pressure.
  • High attention to detail with strong decision-making discipline.
  • Detail-oriented with a proven track record of managing high processing volumes without compromising quality
  • Are customer-focused and excellent at building relationships with stakeholders and delivering clear, empathetic communication.
  • Experience supporting multiple markets is an advantage.
  • Team players; are eager to learn and grow in a fast-paced, collaborative environment that values innovation and service excellence.

Great Eastern