Claim Assessor, Senior Officer

Mô tả Công việc
Claims Assessment & Decision Making
• Evaluate both major and minor claims.
• 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
• Work with TPA and partners to ensure SLA adherence
• Build and improve Claim process to have better service to customer but still control fraud condition
Investigation & Fraud Control
• Assign and review investigation tasks
• Identify fraud indicators (Red Flags) in both minor and major Claims (e.g., fake invoices, split claims, non-disclosure, staged accidents).
• Support audit and compliance reviews
Process and System Development & Optimization
• Contribute to claims process enhancement
• Ensure compliance with internal control and regulations
• Participate in system improvement projects (Requirement gathering, UAT)
• Monitor claim data integrity to support accurate reporting and actuarial analysis.
Customer & Complaint Handling
• Handle Claims Complain to resolve case and avoid affecting the company's reputation.
• Handle inquiries and complaints professionally
• Communicate clearly with customers
Coach/Mentor new Officers.
Other tasks as requirement from OP director/ Manager