Operational Specialist (Cantonese speaking, remote)
Second TalentKota Bharu, Kelantan, Malaysia1 day ago
Job descriptionBachelor’s degree in business, finance, insurance, health administration, or a related field. Minimum 2‑3 years’ experience in claims management, ideally in life / health insurance or a digital health platform in Asia. Preferred experience with claims operating systems, workflow automation, and data analytics tools; proficiency in Microsoft Office and relevant claims management software. Sound knowledge of insurance regulations, industry standards, and digital health compliance requirements in Asia. Strong analytical, investigative, and problem‑solving skills with a keen eye for process optimization. Excellent communication, negotiation, and interpersonal skills; able to engage diverse stakeholders and influence outcomes. Self‑driven, results‑oriented, and comfortable working in fast‑growing, dynamic, and digital‑first environments. Strong language capabilities especially in Cantonese, Mandarin as well as English. Seniority level : Mid‑Senior level Employment type : Full‑time Job function : Information Technology Industries : IT System Custom Software Development
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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Operational Specialist • Kota Bharu, Kelantan, Malaysia