Claims Executive

The Claims Executive – Responsible for end-to-end claims management for MHIT policies, covering claim intake, registration, validation, adjudication, and processing. The role ensures full compliance with MHIT claims guidelines during the Pilot phase, while establishing a scalable, system-enabled operating model to support National Launch.

Principal Duties and Responsibilities

1. End-to-End Claims Management

• Oversee the full claims lifecycle for MHIT policies, including intake, registration, document validation, adjudication, and payment processing.
• Ensure timely and accurate claims decisions in line with policy terms and MHIT guidelines.

2. Claims Governance, Risk and Compliance

• Ensure strict adherence to MHIT claims guidelines, regulatory requirements, and internal policies.
• Establish robust governance, audit trails, and documentation standards for all claims decisions.
• Manage exceptions, escalations, and complex claims cases with appropriate stakeholder alignment.

3. Stakeholder Coordination and Issue Resolution

• Coordinate closely with internal teams (Ops, Health, IT, Risk, Compliance) and external stakeholders (e.g., MHIT ecosystem partners, TPAs, hospitals).
• Facilitate alignment across functions to ensure smooth claims processing and issue resolution.
• Support communications with regulators and senior management where required.

4. Process Improvement and National Launch Readiness

• Design and implement a scalable, efficient, and system-enabled claims operating model to support MHIT National Launch.
• Identify process gaps during Pilot phase and drive continuous improvements.
• Partner with technology teams to enhance automation, system integration, and digital capabilities.

Requirements Education and Professional Qualifications

• Bachelor's degree in Insurance, Business Administration, Finance, or a related discipline.
• Professional qualifications in insurance or life insurance, such as ACII, AMII, AAII, FLMI, or equivalent, would be an advantage.

Experience

• At least 2 years of relevant experience in claims management, preferably within health or medical insurance and/or takaful.
• Strong knowledge of life insurance products and policy provisions is essential.
• Strong knowledge of claims adjudication, policy interpretation, and regulatory requirements.
• Proven experience in driving process improvement and system-enabled transformation initiatives.
• Strong stakeholder management and communication skills.
• High attention to detail, governance mindset, and ability to manage complex cases and escalations.

Pay: RM4,000.00 - RM6,000.00 per month

Education:

• Bachelor's (Required)

Experience:

• life insurance product: 2 years (Required)
• claims management : 2 years (Required)

Work Location: In person