Senior Executive, Claims

Job Description

• Assess and adjudicate Life and Medical claims within authority limits in accordance with policy terms and conditions.
• Conduct claims investigations where necessary, including reviewing medical evidence, policy documentation, and other relevant information to determine claim validity.
• Identify, investigate, and escalate complex claims to the Claims Manager for further review.
• Handle escalation enquiries from policyholders, intermediaries, healthcare providers, and internal stakeholders, providing timely and professional resolutions.
• Handle appeals, complaints, and disputed claims, ensuring fair and consistent outcomes while maintaining a positive customer experience.
• Support continuous improvement initiatives and contribute to enhancing claims processes and customer service standards.
• Perform any other duties as assigned by the Claims Manager.

Job Specification

• Degree in any discipline.
• At least 3 years of experience in Life or Medical Claims handling.
• Certification in Health Insurance and General Insurance (BCP, PGI & ComGI) and Life Insurance qualifications.
• Ability to review and interpret medical reports, hospital bills, policy contract provisions, and investigation findings.
• Excellent communication and interpersonal skills.
• Good customer service, complaint-handling, and stakeholder management skills.
• Strong analytical, investigative, organizational, and time management skills, with attention to detail.