Full Time Claims Adjudicator Jobs, salary up to MYR 3,500 in MSH Sea Sdn Bhd Kuala Lumpur - Ricebowl

Diploma or Degree in Medical Sciences, Languages, Office Administration or any related field

Minimum 1 year of experience in customer service, call centre or any customer-facing role

Excellent command of English (spoken and written) is mandatory

Strong communication skills with the ability to handle complex inquiries professionally

Fast learner with the ability to adapt quickly in a fast-paced, high-call-volume environment

Proficient in Microsoft Office, email management and general IT systems

Prior experience in insurance, Third Party Administration (TPA) or medically related establishments is an added advantage

Fluency in additional languages such as Mandarin, French, Japanese, Thai, Korean or Spanish is a strong plus and may result in higher compensation

Deliver high-quality customer service to insured members by managing high volumes of incoming and outgoing calls professionally and efficiently

Process simple adjustment claims and reimbursement requests accurately within defined Service Level Agreements (SLAs)

Respond to member queries related to policy benefits, claim status, claim adjustments and coverage details

Issue Letter of Guarantee (LOG) to medical providers in compliance with policy terms, limits and internal procedures

Handle prior approval processes and assist members in understanding their benefit entitlements

Coordinate with the medical team for emergency cases and complex approvals

Ensure strict adherence to turnaround times (TAT) and maintain smooth call flow management

Identify and escalate complaints, unresolved cases or potential fraud cases to supervisors promptly