Major Claims Manager

• Assessment and approval of Major claims & PA claims within the defined approval authority limit set and committed service level
• Review processes to propose new guidelines, rules & requirement, procedures and system enhancement for operational efficiency and effectiveness
• Constantly monitor and review pending claims and appeal within the committed service level and make appropriate revised decision if it is within the authority limit
• Handle enquiries and provide quality customer service to clients and agents including investigating into customer/agent’s complaints on delay in claims assessment
• Conduct closed file and open file audit review of junior assessors
• Liaison with Consultant Doctor and other Insurers to determine validity and liability of the Company
• Support other section within the dept. to ensure efficiency
• Assist Superior in the monitoring of Daily TAT, Penders’ File and work performance towards the objectives and goals of the dept
• Assist to provide training for junior staff and contract staff
• Clearing of Suspense Account and UMA reporting
• Conduct Agency Workshop
• Involve in BCP, DRP testing
• Adherence to Insurance Act 1996, AMLA, Standard Operating Procedures, Bank Negara Malaysia guidelines and Office Procedures
• Handles correspondence, draft, type and send: simple general correspondence to customers, standard letter to customers, doctors etc. for further information, standard approval and rejection letter
• Ensure accurate and timely report submission to Accounts Department and any other relevant parties
• Undertake any other job-related functions as and when directed or instructed by immediate superior or any other person as may be designated by the Company
• To assess, review cases for higher approval amounts
• To manage the Major Team with subordinate
• To take part actively in system enhancement issues including but not limited to User Requirement preparation, to fine-tune the current claim processes to an optimum process to achieve a better Turn-Around Time
• To take part in Product Implementation Committee(PIC) meeting and to work towards getting system readiness for new product launching including but not limited to product specification review, to prepare the system readiness, to raise the needed enhancement, provide claims processing material/guideline and to make sure the system is ready for the new product launching
• To constantly look ways to improve the current process and to raise the needed enhancement to simply and improve productivity
• To conduct monthly update to the team on the latest guideline, new product and etc
• To maintain, update the claims manual on yearly basis
• Any task that is not mentioned above as long as it is to support the team in day to day operation

• Bachelor's Degree in Insurance, Business, or a related field
• At least 5 years of experience in claims assessment, preferably in the insurance industry, with a proven track record in handling Major Claims & PA claims
• Experience in a leadership or supervisory role, particularly managing a team of junior assessors, is an advantage
• Comprehensive understanding of the Insurance Act 1996, AMLA, Bank Negara Malaysia guidelines, and standard operating procedures

Ability to leverage AI tools like ChatGPT for data analysis and generating actionable insights