Claims Manager

JOB SCOPE:

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 & RESPONSIBILITIES:

End-to-End Claims Operations

 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. Compliance & Governance

 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 Management

 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 Design & Transformation

 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.

5. Team Leadership

 Lead and develop the MHIT claims team, fostering strong operational discipline and continuous improvement of culture.

 Build capability in complex claims assessment, governance, and stakeholder management.

REQUIREMENTS:

Education : Bachelor’s degree in Insurance, Business, Finance, or related discipline and/or a professional qualifications in life insurance. ACII, AMII, AAII, FLMI, etc..

Experience : Minimum 8–12 years of experience in claims management, preferably in health/medical claims.

KSA’s:

: Well versed in Life Products is a must.

: 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, with ability to engage senior leadership.

: High attention to detail, governance mindset, and ability to manage complex cases and escalations.

Pay: RM8,000.00 - RM10,500.00 per month

Education:

• Bachelor's (Required)

Experience:

• MHIT policies: 5 years (Preferred)
• Life insurance product: 5 years (Required)
• end to end health/medical claims management : 8 years (Required)

License/Certification:

• ACII, AMII, AAII, FLMI (Preferred)

Work Location: In person