Handle follow-ups on claims with unsuccessful bank transfers and CPF failures, such as voiding claims, creating refund entry and reprocessing of claims.
Request and follow-up on the creation of insured members and medical service providers for affected claims.
Prepare claim settlement letters and scan claims documents to shared drive.
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Manage corporate expenses to ensure appropriateness.Ensure compliance with all legal, regulatory, and internal control requirements.
Provide claims insights to assist business units by collaborating in product development, customer/broker stewardship and prospect meetings.
Motivate and lead the team by communicating job expectations, monitoring, and evaluating performance, providing feedback and facilitating employee development.
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Establish proof of loss by studying medical documentation; assembling additional information as required from other sources, such as claimant history, physician, employer, hospital details, type of medication, procedures & etc. Escalate questionable claims to the direct supervisor / medical advisory officers (if required).
Ensure confidentiality of all claims information, inclusive of claims guidelines and internal controls.
To identify Process improvement ideas & initiatives leading to greater operations effectiveness and efficiency..
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Establish appropriate claim reserves and conduct ongoing monitoring and updates throughout the claim lifecycle.
Liaise with internal stakeholders and external parties including brokers, agents, adjusters, insureds, third parties, solicitors, financial institutions, and regulatory bodies (e.g., Bank Negara Malaysia, FMB).
Escalate complex, high-value, or high-risk claims to the Claims Unit Head or Senior Management in a timely manner.
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