Head of Family Claims - Kuala Lumpur

job description

The Company

Our client is a prominent Insurance company .Currently seeking a skilled and strong Head of Credit Controller to lead a team of professionals and to also deal with their international clients.

The Role

The Head Of Family Claims reports to the Vice President , encompassing the below skillset .

Head Of Claims

– To ensure All Family claims assessments, processing, compensation and approval are justified and done to guidelines and standards set.

– To monitor and liaise with MCO to ensure admission and discharge process are done as per standards agreed

– Produce and analyze reports on claims experience and provide appropriate recommendation in claims cost containment to the management

– To be responsible for matters related to the following committees:

1) Management Committee (member)

2) Family Claims Committee (member)

Essential Functions

1. Manage and provide direction and leadership to all subordinates in Family Claims and Medical Services Department


2. Monitor and recommend strategies and ideas to improve the department


3. Monitor processes and procedures to ensure utilization of best practices and optimum efficiencies in managing claims to ensure reduction in claims processing time; minimize unnecessary investigations and efficient detection of fraudulent claims


4. Monitor the performance of MCO as per agreement in the SSA and to liaise MCO to facilitate admission and discharge process of medical claims.


5. To do analysis of claims pattern to identify- claims risk which can be used as a guide by underwriting and marketing – inappropriate charges by health care providers whom can be blacklisted or removed from panel ship


6. Operation and Management


7. Supervise, coordinate and monitor the quality assurance of Claims in:

• Registration,


• Processing


• Approval and Settlement (including appeal)


• Reporting

8. Monitor and implement information integration and industry practice changes


9. Monitor and ensure that all deadlines for the claims are followed and met strictly


10. Develop guidelines and procedures for the department for continuous efficiency


11. Maintain the claims approval up to the different levels of authority limits are being adhered to.


12. Prepare and monitor a timely reporting to regulatory authorities, nominated third parties, agency members, relevant departments and management


13. Provide prompt response to/from Retakaful Operators/ Reinsurance, BNM, MTA, ISM, MCO, marketing and branch personnel, agency members and applicants/ certificate holders


14. Provide prompt response to all complaints by BNM, FMB, agency members, certificate holders and concerned parties. Work closely with complaints unit and relevant department if requires so


15. Attend and/ or arrange meetings with relevant parties, Internal or External Committees


16. Recommend and monitor appointment of panel hospitals and clinics


17. Supervising the performance of subordinates


18. Assist Head of Family Technical in all matters related to Family Claims


19. Technical Support


20. Provide, Coordinate and monitor claims and technical support. Assist Head of Technical in conducting the claims training to agency members, marketing and branch personnel and fellow staff


21. Compliance

• Coordinate and monitor requirements of the Takaful Act 1984, Bank Negara Guidelines, MTA Guidelines, Internal and External Service Level/ Benchmark, Bank Negara Audit and External Audit are complied with.

Skills & Experience

• Education:- Degree


• Experience: 10 years in Takaful Family Claims/ Life Insurance Claims


• KSA’s : Adequate Claims knowledge and ability to head the Family Claims & Medical Services Dept


• Knowledge of applicable law and regulation governing the Takaful operation and Family product plans.


• Ability to manage a team of staff to meet the standards sets by management