Senior Executive, Claims

Job Description • Assess and adjudicate Life and Medical claims within authority limits in accordance with policy terms and conditions. • Conduct claims investigations where necessary, including reviewing medical evidence, policy documentation, and other relevant information to determine claim validity. • Identify, investigate, and escalate complex claims to the Claims Manager for further review. • Handle escalation enquiries from policyholders, intermediaries, healthcare providers, and internal stakeholders, providing timely and professional resolutions. • Handle appeals, complaints, and disputed claims, ensuring fair and consistent outcomes while maintaining a positive customer experience. • Support continuous improvement initiatives and contribute to enhancing claims processes and customer service standards. • Perform any other duties as assigned by the Claims Manager. Job Specification • Degree in any discipline. • At least 3 years of experience in Life or Medical Claims handling. • Certification in Health Insurance and General Insurance (BCP, PGI & ComGI) and Life Insurance qualifications. • Ability to review and interpret medical reports, hospital bills, policy contract provisions, and investigation findings. • Excellent communication and interpersonal skills. • Good customer service, complaint-handling, and stakeholder management skills. • Strong analytical, investigative, organizational, and time management skills, with attention to detail.