Job Scope / Position Summary Responsible for daily assigned tasks in respect of Accident & Health claims in timely manner and within the company's claims manual and related policies and authority guidelines. Manage and settle legitimate claims including leading and monitor efficiency of team members on daily operation duties. Liaise with internal and external customers to achieve resolution on operational issues. Participate and complete timely on the Projects assign. To check, approve claims assessment & & authorize payment done by team members. Adhere to all claim operating guidelines and regulations. All other and related job as stated in the job scope (which may be revised). Main Responsibility Claims Operation Adhere to Claims Guidelines, related company policies and any authority guidelines to endure company is compliant & protected. Proactively address and / or escalate any operational issues and complaint to superior. Provide consultation, supervision and monitor the productivity and workflow of team to ensure team operating efficiently including monitoring team attendance and punctuality. Investigation on suspicious claims and finalized the claims on a timely basis in accordance with the agreed policies, processes and operational procedures. Assist team to handle complex cases such as Appeal claims, 2nd level complaints, high authority cases etc that may arise from time to time. To perform monthly post claims audit (both reimbursement and cashless cases). Claims Costs Manage claims settlement costs and related claims expenses and ensure compliance with internal controls. Participate in proactive claims leakage management including claims training, activities leading to reduce loss ratio etc. Participate in Technical Deep Dive activities and others deemed relevant in managing claim costs & initiatives. Claims Reserving Reserving and File / claims review are completed in accordance with BNM guidelines & Claims Operating guidelines in a timely manner. Assist in ensuring team's accuracy and completion for Claims file review. Service Delivery Manage Third Party Administrator and ensuring they are performing according to SLA including resolving any arising operational concerns. Participate in TPA Management/Outsourcing/Own provider management where/when required. Main liaison officer and handler for Generali Malaysia's Medical Evacuation & Repatriation cases. (Note: In addition to Health, this role includes Travel and PA lines of businesses as well). Recruit, train and develop team members to achieve maximum potential and competency. Provide claims assessment advice to other Claims Units such as but not limited to Travel and PA (Internal Customer). Governance Compliance - comply with the relevant requirements of the Insurance Act, 1996, Bank Negara Malaysia, PIAM, Company policies and procedures, Internal Audit requirements etc. Provide all kind of operational assistance & support for the Dept/Unit Lead. Projects, TPA Management & Reporting Participate in projects initiatives to improve efficiency and productivity of the department/company. Participate in products development, claims reporting and UAT management. Qualification and Experience Requirement Degree in any recognized Institution and/ or Diploma in Nursing. AMII/ ACII/ DMII or equivalent insurance qualifications (is an advantage). Minimum of 5 years' experience in and/ or similar role/ capacity. Good command of written and spoken English/ Bahasa Malaysia with strong communication skill. Good communication and negotiation skills. Result oriented, committed, team player, positive working attitude and good interpersonal skill. Ability to adapt and learn fast, diligent, trustworthy and have strong initiative to learn. Good analytical skills. IT literate, computer literate, especially in MS Word, Excel, Power Point. Ability and interest to lead and develop junior team members. Ability to multi-task, plan effectively and meet deadlines. Very good ability to strategize and drive execution. Show more Show less