[OP] Senior Claims Assessor

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