eMASCO

Claims Manager oversees and manages an insurance claims processing unit to ensure claims are investigated, assessed, and settled accurately and efficiently in accordance with organisational policies, regulatory requirements, and legal standards. The manager plans and coordinates operations, supervises and guides staff, and monitors workflows to manage financial exposure and mitigate risk. The manager also liaises with senior management and relevant functions to resolve complex claims issues and support effective claims governance.

Tasks

Review, assess, and approve claims in accordance with policy coverage, investigation findings, and legal guidelines.

Supervise and lead a team of claims adjusters or officers to ensure efficient and timely claims handling.

Negotiate claim settlements with claimants, policyholders, or third parties in line with policy terms and legal requirements.

Provide technical expertise to resolve complex or high-value claims.

Ensure compliance with industry regulations and company procedures in all claims activities.

Conduct claims-related reviews and investigations to support accurate and fair claims resolution.

Develop and implement strategies to prevent fraudulent claims and manage associated risks.

Monitor claims operations to ensure accuracy in claims processing and financial reporting.

Analyse claims performance and recommend improvements to processes and policies.

K
Financial and Insurance /Takaful Activities

Skills

Basic

Active listening and critical thinking to understand issues and support decision-making.

Analytical skills to review claims data and identify risks or potential fraud.

Attention to detail to ensure accuracy and completeness in claims processing.

Communication skills to explain claims matters clearly to clients and internal teams.

Leadership and people management skills to guide teams and ensure smooth workflows.

Specific

Knowledge of claims data analysis and identification of trends influencing claims patterns.

Knowledge of claims forecasting and assessment of financial impacts.

Knowledge of claims negotiation techniques within policy and legal frameworks.

Knowledge of insurance laws and regulatory requirements related to claims management.

Proficiency in calculating claim settlements in accordance with policy limits and conditions.

Proficiency in claims assessment, risk evaluation, and determination of claim validity.

Proficiency in financial analysis and reporting related to claims operations.

Additional Info

QUALIFICATION

Bachelor’s degree or equivalent

Related Courses

Claimable Course

e-Latih Online Course

Madani TVET Course

Minor Unit Group

1211-01

Budgeting/Financial Accounting Manager

1211-02

Audit and Risk Management Manager

Fund/Portfolio Manager

Actuarial Valuation Manager

1211-10

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Transfer Pricing Manager

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