Deskripsi Pekerjaan
Are you a detail-oriented professional looking to make a tangible impact in the healthcare sector? Integrated Health Plans is currently seeking a dedicated Claims Officer / Executive to join our dynamic team in Johor Bahru. In this pivotal role, you will be responsible for reviewing, assessing, and approving medical claims with a high degree of accuracy, ensuring that we meet our targeted service turnaround times while upholding the integrity of our insurance portfolio.
At Integrated Health Plans, we pride ourselves on our customer-centric approach and our commitment to operational excellence. As a Claims Officer, you will serve as the bridge between our policyholders and our insurance services, ensuring that valid claims are processed promptly and that complex cases are resolved efficiently. This is an excellent opportunity for a driven individual to grow their career in a stable and supportive environment within the Insurance & Superannuation industry.
Tanggung Jawab
- Review and assess incoming medical claims to ensure accuracy and completeness of all submitted documentation.
- Verify policy coverage details and eligibility of claimants against the relevant insurance contracts.
- Make informed decisions to approve or reject claims based on policy terms, medical evidence, and internal guidelines.
- Investigate and resolve complex claims or discrepancies, escalating issues to senior management when necessary.
- Communicate claim decisions and detailed rationales to policyholders in a clear and professional manner.
- Maintain accurate, up-to-date records of all claims processed within the claims management system.
- Meet and exceed daily/weekly Service Level Agreements (SLAs) regarding claim turnaround times.
Kualifikasi
- Diploma or Bachelor’s degree in Business Administration, Finance, Actuarial Science, Healthcare Management, or a related field.
- Minimum 1-2 years of proven experience in insurance claims processing, underwriting, or healthcare administration.
- Strong understanding of medical terminology, healthcare insurance policies, and claim adjudication processes.
- Excellent analytical skills with the ability to interpret data and make sound judgment calls.
- Proficiency in using MS Office Suite (Word, Excel, Outlook) and claims management software.
- Strong verbal and written communication skills in both English and Bahasa Malaysia.
- The ability to work independently, manage multiple priorities, and meet tight deadlines under pressure.