Job Description

Specific Responsibilities:

• Assists customers in analyzing and refining their queries in order to accurately fulfil claims requests.
• Managing key claims handling enquiry; coverage determination and liability assessment for hospital claims, where appropriate within authority limits and providing a consistently strong standard of customer service.
• Ensuring effective management of claims within a personal allocation.
• Broader internal / external stakeholder communication where required.
• Continuous improvement on claim files handling with feedback and support the operations as well finance processes.
• Providing timely service throughout the life of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquires according to company policy and procedures.
• Contribute to the maintenance of best practice procedures for hospital, insurance and etc. claims, consistent with global best practice.
• Be proficient in complex claims processes.
• Demonstrate a basic competence and fraud detection analytic skill.
• Demonstrate a strong standard of competence in handling and resolving claims within standard service level of claims handling.

• Intermediate knowledge in hospital, travel & etc. claims topics and experience.
• Policy language skills enabling accurate and consistent policy wording interpretation.
• Good communication skills, both written & verbal.
• Good time management ability to manage & prioritize workload and diary management.
• Ability to contribute effectively within a team environment.
• Ability to work with claims stakeholders to effectively direct claims strategy.
• Good critical thinking, decision-making and negotiation skills

EMA GLOBAL Assistance Sdn Bhd