Senior Claims Executive

Location: OUG Parklane, Malaysia
Job Titles: Junior Claims Executive / Senior Claims Executive

Job Summary

The Senior Claims Executive will additionally handle complex cases, mentor junior staff, and support claims process improvements.

Key Responsibilities

• Handle complex or high-value claims, providing in-depth analysis and investigation as necessary.
• Review and approve claims processed by junior staff, ensuring accuracy and adherence to company policies.
• Mentor and train junior Claims Executives on claims handling procedures and best practices.
• Collaborate with management to implement process improvements and develop streamlined claims workflows.
• Conduct periodic audits of claims to ensure compliance with industry regulations and internal standards.
• Act as a primary point of contact for escalated claims issues, working closely with healthcare providers, insurers, and clients to resolve disputes.

Key Requirements

Education and Experience:

• Diploma or bachelor’s degree in healthcare, Business Administration, Finance, or related field.
• Senior Claims Executive: 3-5 years of experience in healthcare claims processing, with exposure to complex claims management and team leadership.
• Familiarity with healthcare claims systems and regulations is preferred.

Skills:

• Strong attention to detail and accuracy in reviewing and processing claims.
• Excellent communication skills, with the ability to handle sensitive healthcare and financial information confidentially.
• Proficiency in MS Office Suite, especially Excel, for record-keeping and reporting.
• Analytical thinking and problem-solving abilities, especially for handling complex claims (Senior role).
• Ability to work effectively in a fast-paced environment, with strong time management skills.

Attributes:

• Customer-oriented with a professional demeanor in handling claims inquiries.
• Proactive and adaptable, with a commitment to continuous improvement.
• Leadership qualities, including the ability to mentor and guide junior staff.

Benefits

• Competitive salary package with performance-based incentives.
• Comprehensive health and wellness benefits.
• Opportunities for professional growth and development.
• Supportive work environment focused on innovation in healthcare services.