- Provide accurate and efficient adjudication of claims to meet operational and SLA targets.- Conducted regular reviews of current claims processes and worked with internal teams and clients on improved processes to improve efficiency and overall claims experience.- Managed escalations and maintain good terms with clients.- Liaise with the clients to verify exceptions as well as to resolve any complaints- Generated weekly and month-end payment reports and sent them directly to the clients. - Maintained an outstanding relationship with clients and internal teams such as the Finance team.

- Examined claims on a global scale (Asia, Africa, North America, South America, Europe, and Australia).- Assessed and processed claims for medical expenses while always bearing in mind the importance of medical confidentiality within a given processing time.- Examined claim forms to verify insurance, amounts, and currencies. - Utilized multiple processing systems (Act-isure, Salesforce, Sharepoint) to process claims.- Utilized fraud detection skills to decrease the incidence of fraud and alerted higher management if any. - Reviewed and resolved payment issues. - Meet Service Level Agreement requirements, team KPI(s), monthly quality audit scores, and NPS (Net Promoter Score). - Handle recoupment and reconciliation work, and communicate with providers and members via email for explanation and collection. Work with cross-function teams, such as Finance, CSR, Eligibility, Network, and Client Management to ensure recoupment work goes smoothly.- Organized games for KL claims team on every Thursday with Supervisor’s guidance.

- Assessed and provided accurate adjudication of In-patient claims, validation, pre-authorization of applications, and LOG/GOP issuance to meet operational and SLA targets in line with policy guidelines. - Responsible for claim settlement and ensuring payments are processed within the agreed turnaround time and service standard.- Liaise with Call Centre/Customer Service, hospitals, agents, brokers, and third-party administrators (TPA) in the handling of GLs, and admission/discharge-related matters. - Liaise with medical doctors on medical inquiries.- Responsible for managing customer inquiries through emails/calls, and providing a response in a timely manner.- Participate in project initiatives to improve the efficiency of the current claim process and the productivity of the department.

- Operated sophisticated equipment and instruments to identify the results.- Processed patient specimens according to priority and documented results.- Kept laboratory equipment clean and in good working order for optimal functionality and longevity.

• Hourly wages (RM 8/hour), part time worker• Provide excellent Customer Service at all times by well knowing all the products of Royal Selangor / Comyns & Selberan .• Fielded customer questions regarding available merchandise, sales, current prices and upcoming company changes.• Recommended related products to increase customer’s options and also enrich the shopping experience. • Helped customers complete purchases, locate items and join reward programs to promote loyalty, satisfaction and sales numbers.• Others ad hoc tasks assigned by superior.