[OP] Senior Claims Assessor

Mô tả Công việc

Perform the role of a Claims Assessor responsible for evaluating, analyzing, and making fair and timely claim decisions in accordance with MB Life’s Terms & Conditions, internal guidelines, and regulatory requirements. Support investigation activities, coordinate with stakeholders, and contribute to the continuous improvement of claims service quality.

1, Claims Assessment & Decision Making

• Evaluate both major and minor claims (Death, TPD, CI, WOP, PPD, AHI, HSCR, etc.)
• Review claim documents and request additional info as needed
• Identify and handle non-disclosure, misrepresentation, or fraud cases
• Liaise with Reinsurance for concurrence
• Make decisions within authority limits
• Build and improve the Claim process to have better service to customers, but still control the fraudulent condition

2, Investigation & Coordination

• Assign and review investigation tasks
• Work with TPA and partners to ensure SLA adherence
• Support audit and compliance reviews

3, Process Improvement & Compliance

• Contribute to claims process enhancement
• Ensure compliance with internal control and regulations
• Participate in system improvement projects. Handle Claims Complaints to resolve cases and avoid affecting the company's reputation. At the same time, pain points are defined to improve the service

4, Customer & Complaint Handling

• Handle inquiries and complaints professionally
• Communicate clearly with customers
• Support resolution of escalated cases

5, Other tasks as required by the COO/ OP Director/ Manager

Yêu Cầu Công Việc

1, Education: University degree in economics, finance, medicine, law, or equivalent

2, Experience: Minimum 3 years in life insurance claims as an assessor to handle major and minor claims

3, Certification: LOMA/ALMI/FLMI preferred

4, Language: Good English reading and writing skills.

5, Others:

• Understand the T&C, follow the processes to meet TAT and SLA, proactive evaluate customer requirements and make the right decisions, and communicate effectively with customers.
• Customer-centric thinking.
• Have a good teamwork spirit and can work independently