全职 Claim Operations Manager- Assistant Manager 工作, 薪水, Second Talent 公司招聘中 - Ricebowl

• Claims Operations Manager / Assistant Manager
• Type: Remote - Fulltime Permanent role
• Salary range: RM 8.000 - 12.000 (Including EPF, Tax, Socso)
• MUSTHAVE Requirement: Experience in healthcare claming, can speak Cantonese and Mandarin Speaking

The Role: We are seeking an agile, tech-forward Claims Operations Specialist to join our Digital Employee Benefits team. You will play a critical role in delivering seamless, high-quality claims experiences across our self-funded inpatient and outpatient portfolios, as well as our digital wellness marketplace. Moving beyond legacy paper processes, you will oversee and refine our Claims Adjudication Processes, ensuring our members enjoy instant, accurate claim resolutions while maintaining a 100% digital ecosystem.

Key Responsibilities:

• Manage the daily oversight of claims servicing, validating the outputs to ensure accuracy and compliance with customized corporate policy rules.
• Process and investigate exception claims across self-funded inpatient, outpatient, and wellness categories, intervening when there are anomalies or requires review.
• Work with customer success team on investigating customer appeals cases as well as claw back cases.
• Collaborate with product and engineering teams to refine AI prompts and logic, driving continuous improvement to maintain our benchmark of reducing processing time.
• Liaise seamlessly with corporate HR administrators, a network of panel doctors, and external partners to resolve escalated inquiries and facilitate a frictionless digital health journey.
• Monitor real-time utilization dashboards to spot trends, fraud vulnerabilities, or system bottlenecks, proposing workflow enhancements.
• Support Operations team on any ad hoc tasks.

Requirements:

• Minimum 2 years of relevant experience in health insurance claims, employee benefits administration, or health-tech customer success.
• A recognized Bachelor's degree in Business, Healthcare Administration, Risk Management, or a related discipline.
• Strong digital literacy; comfortable navigating SaaS platforms, AI-driven backend systems, and data analytics dashboards.
• Experience with process automation or transitioning from manual "pay and claim" models to cashless or AI-driven systems is a distinct advantage.
• Proficient in both spoken and written English and Cantonese and Mandarin