Key Accountability

• Assess and adjudicate insurance claims in accordance with policy terms, medical evidence, and regulatory requirements
• Ensure timely processing and settlement of claims within agreed service level agreements (SLAs)
• Review and verify claim documentation to ensure completeness and validity
• Identify, investigate, and escalate potential fraud or non-disclosure cases in line with internal procedures
• Collaborate with Underwriting, Medical, Legal, Compliance and Customer Service teams to resolve complex cases; Communicate claim decisions clearly and professionally to internal stakeholders and customers (where applicable)
• Maintain accurate claim records and system entries to support reporting and audits
• Contribute to continuous improvement initiatives, including process enhancement and control strengthening
• Perform other tasks and assignments as directed by the Head of Department to support operational, control, or improvement initiatives

Job Requirements 

Education

• Graduated from College/University in majors such as Insurance, Medicine–Pharmacy, Nursing, Public Health, Finance–Banking, Law, or other related fields.
• Basic knowledge of life/health insurance is an advantage.

Experience

• 0–1 year of experience in Claims, Insurance, TPA, hospitals, or related administrative/operational work.
• Fresh Graduates with a long-term career orientation in the insurance/claims industry are accepted.
• Experience in handling records, documents, and data is an advantage.

Knowledge & Skills

• Skills in analyzing and reviewing records, with attention to detail, carefulness, and accuracy.
• Clear communication skills for interacting with customers/agents/related departments.
• Proficient in MS Office (Excel, Word); willing to learn internal operational systems.
• Ability to manage time and handle tasks according to SLA.

Personal Attributes

• Honest, compliant with regulations, and upholding professional ethics.
• Proactive in learning, ambitious, and open to feedback and guidance.
• Team-oriented with good cooperation attitude.
• Able to work under pressure when workload increases.

Language

• English: Basic (reading and understanding documents, medical/insurance terminology is an advantage)

Benefits

• Competitive salary (100% salary during probation)
• Bonus: 13th-month salary and the performance-based bonus of up to 30% of the total annual package.
• Full social insurance, personal accidental & health care insurance, group life insurance (death and dismemberment).
• Gifts for newcomers and on special occasions
• Modern facilities in the spacious office
• 15 Annual leaves