PMCare Hiring! Full Time Claims Executive in Selangor - Ricebowl

Role Description This is a full-time, on-site Claims Executive role based in Subang Jaya. The Claims Executive is responsible for reviewing, validating, and processing medical claims in accordance with company policies and client benefit structures. Day-to-day tasks include verifying documentation, assessing claim eligibility, resolving discrepancies, and ensuring timely and accurate claim adjudication. The role also involves communicating with providers, clients, and internal teams to clarify claim details, handle inquiries, and provide updates on claim status. The Claims Executive is expected to maintain high standards of data accuracy, comply with regulatory and company guidelines, and contribute to continuous improvement of claims p

• Strong analytical skills to review, interpret, and validate claim information and medical benefit structures.
• Experience in claims handling and claims management within healthcare, insurance, or related administrative environments.
• Proficient customer service skills to manage inquiries, address concerns, and provide clear, courteous support to clients and providers.
• Effective communication skills, including the ability to explain claim decisions, document findings, and collaborate with internal and external stakeholders.
• High attention to detail and accuracy in data entry and documentation.
• Ability to work in a fast-paced environment, manage multiple cases, and meet processing timelines.
• Familiarity with healthcare benefits, medical terminology, or TPA operations is an advantage.
• Comfort with using claims processing systems and basic office software (e.g., spreadsheets, databases, email).