Senior Claims Representative
Posting Date : 23 Nov 2022 | Close Date :21 Feb 2023

Client Background: Belgium MNC- one of the largest health service organizations with 60 million customer relationships across the world and support this with a worldwide staff of 30,000 employees.

Industry: Insurance Service Provider

Location: KL

Tenure: Permanent

Remuneration: RM350 Convenient Allowance, Incentive, Performance Bonuses, Flexi Working Hours and 3months Maternity Leave & more.

Outline of the Role:


You will have all of the skills, knowledge and experience of a Customer Service or Claims Advisor. However, we’re looking for more than that - you will have a real desire to use your knowledge to help drive our customer experience to a new level.


You will use all of your knowledge and experience from a Claims & Customer Service background to drive a real ‘Category of One’ experience. Your understanding of the customer journey will ensure that your customer queries are resolved at point of contact. This will be demonstrated in a high first time resolution score.


Main Duties / Responsibilities:


           Adjudicate international medical, dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.

           Identify claims where further information is required working towards SLA and timescales.

           Monitor and highlight high cost claims and ensure relevant parties are aware.

           Monitor turn-around-times to ensure your claims are settled within required time scales to meet client SLA’s.

           Identify potential process improvements and make recommendations.

           Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first contact resolution where possible.

           Actively support other team members and provide resource to enable all team goals to be achieved.

           Manage customer instructions through the development of high quality interpersonal skills.

           Achieve personal and team productivity and quality goals.

           Ensure work is prioritized effectively.

           Work across European businesses and closely with other departments in line with service needs.

           Interface effectively with internal and external businesses to resolve customer issues.

           Carry out other adhoc tasks as required meeting business needs.

           Performs research to respond to inquiries and interprets policy provisions to determine most effective response.

           Flex between all of the above activities based on current customer demand.

           Flex your working shift based on current customer demand.



Experience Required:


           A minimum of 12 months experience in medical administration, claims environment or customer service focused organization.

           Ability to meet/exceed targets and manage multiple priorities.

           Proficient in Microsoft Office applications.

           Case and Claims management system experience.

           Preferred if English and Arithmetic qualifications gained.





           Preferred language: Fluent in English. Other languages like French, German, Dutch, Spanish, Russian, etc. will be useful.

           Must possess excellent attention to detail, with a high level of accuracy.

           Strong interpersonal skills with good verbal and written communication to internal and external clients. This will incorporate call handling skills.

           Confident in making decisions and exercise judgment where necessary.

           Strong customer focus with ability to identify and solve problems without supervision.

           Ability to work under own initiative and proactive in recommending and implementing process improvements.

           Ability to organise, prioritise and manage workflow to meet individual and team requirements.

           Ability to maintain high levels of customer satisfaction by dealing with member/client enquiries in an effective and timely manner is essential for this role.

           Ability to adapt to change depending on requirements. 

           Self-starter and able to motivate others.

           Ability to exercise judgment.


If you are interested in the position, kindly apply directly online by clicking on the “Apply” button. Thank you.



Sub Specialization : Others;Any
Type of Employment : Permanent
Minimum Experience : 1 Year
Work Location : Kuala Lumpur