Senior Adjuster, Insurtech Claims Development

Job Description: Senior Adjuster (AI-Powered Insurance Claims Development)

Location: Kuala Lumpur, Malaysia

Employment Type: Full-Time

About the Role

We are seeking a highly experienced Senior Adjuster to play a key role in the design, validation, and testing of an AI-powered insurance claims automation platform. This system will analyse medical reports, police reports, and supporting evidence to automatically generate claim summaries, assess liability, and recommend quantum of damages for bodily injury and general insurance claims.The successful candidate will combine deep expertise in claims adjudication and injury assessment with a strong understanding of claims processes, documentation standards, and negotiation practices. You will collaborate with AI engineers, product managers, and data scientists to ensure the product’s decision logic and outputs align with real-world adjusting standards and regulatory requirements.

Key Responsibilities

1. Product Design & Validation

· Define rules, logic, and workflows for claims triage, assessment, and settlement.

· Validate AI-generated summaries, injury classifications, and compensation ranges against case precedents and industry guidelines.

· Collaborate with engineers to train and test the AI model’s accuracy, interpretability, and audit trail design.

· Provide feedback on system usability, documentation standards, and human–AI interface design.

2. Knowledge Engineering & Data Structuring

· Curate reference data including quantum tables, medical injury codes, and precedent databases for training datasets.

· Assist in structuring templates for medical report summaries, injury chronologies, and liability matrices.

· Support annotation and classification of historical claims for supervised learning.

3. Regulatory & Compliance Alignment

· Ensure all AI outputs and recommendations are consistent with Bank Negara Malaysia (BNM), PIAM, and other relevant standards.

· Develop guidelines and audit controls for explainability and compliance in automated claims handling.

4. Market & Product Development

· Provide domain insights to shape the commercial strategy, user adoption, and insurer integration roadmap.

· Conduct workshops and training sessions for insurers, adjusters, and lawyers to familiarise them with the AI tool.

· Contribute to development of product documentation, claim scoring systems, and benchmarking dashboards.

Key Competencies & Skills

· Deep expertise in motor, bodily injury, and general insurance claims.

· Strong analytical and documentation skills, with ability to summarise complex medical and legal data.

· Familiarity with Merimen, ISCS, or similar claims management systems.

· Experience with quantum assessment, liability apportionment, and negotiation frameworks.

· Understanding of AI applications or openness to technology collaboration.

· Excellent written and verbal communication skills (English and Bahasa Malaysia).

Qualifications & Experience

· Minimum 10 years of experience in insurance claims adjusting, investigation, or related roles.

· Professional certification in loss adjusting (e.g., from MII, CILA, or equivalent) preferred.

· Exposure to digital transformation projects in insurance or claims management an advantage.

· Legal or medical background desirable but not required.