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Major Group

Technicians and Associate Professionals

Sub-Major Group

Business and Administration Associate Professionals

Minor Group

331

Financial and Mathematical Associate Professionals

Unit Group

3312

Credit and Loan Officers

Minor Unit Group

MASCO Code

3312-02

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Claims Executive

TVET

TVET scope is based on recognized occupational standards, with emphasis on practical components, psychomotor skills and exposure to training in the industry

Claims Executive manages and facilitates the processing of insurance claims, ensuring claims are reviewed, investigated, and resolved fairly and in accordance with policy terms and regulatory requirement. They act as the primary contact for clients, liaising with insurers and relevant stakeholders such as hospitals, repair workshops, or legal advisors, while maintaining accurate records and preparing reports on claims activities. This role ensures the smooth administration of claims and provides guidance to their clients throughout the claims process.

Tasks

Receive and register insurance claims submitted by policyholders or third parties.

Review policy terms and conditions to determine claim eligibility and coverage.

Investigate claims by interviewing claimants, contacting service providers, and gathering supporting evidence.

Coordinate with underwriters, legal advisers, loss adjusters, and other assessors to verify claims and determine claim value.

Assess and calculate claim settlements in accordance with policy provisions and regulatory requirements.

Communicate claim decisions to claimants and explain reasons for approvals, adjustments, or rejections.

Update claims management systems and maintain accurate claim records and documentation.

Handle complaints or disputed claims and escalate complex cases to senior management or legal teams.

Ensure claims processing complies with company policies, insurance guidelines, and relevant regulatory requirements.

Prepare reports on claims activities for internal monitoring, audits, and regulatory review.

K
Financial and Insurance /Takaful Activities

Skills

Basic

Ability to manage multiple tasks and high-volume claims efficiently.

Attention to detail for reviewing policy and claim documents.

Basic computer proficiency, including Microsoft Office and digital claims platforms.

Customer service orientation and conflict resolution skills.

Strong written and verbal communication skills in widely used languages.

Specific

Ability to coordinate with underwriters, legal advisers, loss adjusters, and other assessors.

Calculate settlements in accordance with policy provisions and regulatory standards.

Competency in analysing claims to identify and flag potential fraud.

Ensure compliance with local and international insurance regulations, including Bank Negara Malaysia standards.

Knowledge in interpreting medical reports and medical coding for health insurance claims.

Proficiency in claims management systems, including digital platforms.

Understand insurance concepts, policy clauses, and exclusions.

Additional Info

QUALIFICATION

Diploma or equivalent

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