Operational Specialist (Cantonese speaking, remote)

Operations / Senior Operations Executive (Claims) — Health Tech Platform

Salary range : RM 3,000 - RM 4,000 (including EPF, Tax, Socso)

Key Responsibilities

• Manage and oversee a portfolio of complex claims, ensuring prompt, accurate, and transparent processing in accordance with internal SLAs and regulatory standards.
• Provide guidance, training, and support to claims and customer service team members; act as a Subject Matter Expert (SME) to resolve escalated cases and develop best practices.
• Investigate, assess, and adjudicate claims, including review of documentation, data analytics, and digital health records, to determine eligibility, coverage, and liability.
• Ensure strict compliance with company policies, industry regulations, and evolving digital health legislation in local and international markets.
• Monitor, analyze, and report on claims performance using KPIs and dashboards; drive data‑driven process improvement projects aiming for higher efficiency, automation, accuracy, and customer satisfaction.
• Collaborate cross‑functionally on system enhancements and solve customer enquiries.
• Maintain accurate, up‑to‑date claims databases and generate regular and ad‑hoc management reports for internal and regulatory review.
• Proactively identify operational risks and recommend process or technology improvements.
• Process Business as Usual (BAU) operational processes and any ad‑hoc tasks to improve company efficiency.

Qualifications

Additional Information

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