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Introduction Of MASCO Structure Of Classification Starting Salary Guidelines
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Major Group
3
Technicians and Associate Professionals
Sub-Major Group
33
Business and Administration Associate Professionals
Minor Group
332
Sales and Purchasing Agents and Brokers
Unit Group
3321
Insurance Representatives
Minor Unit Group
MASCO Code
3321-03
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Claims Officer manages and processes insurance claims, ensuring claims are accurately assessed and paid if valid. They investigate claims to determine liability, verify information, and prevent fraud, coordinating with clients, medical professionals, or another party as needed. They prepare reports, liaise with legal teams when necessary, and analyse claims data to manage financial risk, often specialising in an area such as health, motor, property, or life insurance.
Tasks
Receive and review insurance claims to ensure accuracy, completeness, and compliance with policy requirements.
Verify policy details, coverage limits, and supporting documentation related to submitted claims.
Investigate claims by collecting evidence, interviewing claimants, and liaising with insurers, medical providers, or investigators.
Assess claims against policy terms and determine whether they should be approved, rejected, or referred for further investigation.
Calculate and negotiate claim settlement amounts with claimants or their representatives.
Prepare and maintain detailed claim documentation, reports, and case records.
Communicate with claimants to provide updates, request additional information, and explain claim decisions.
Ensure claims handling processes comply with insurance regulations, company policies, and industry standards.
Identify and report suspected fraudulent claims through thorough review and investigation.
Skills
Basic
Attention to detail and analytical thinking for accurate claims assessment.
Conflict resolution and problem-solving skills for handling disputes diplomatically.
Effective multitasking and prioritisation to manage workload efficiently.
Proficiency in MS Office and claims management software.
Strong communication and customer service skills for client interaction.
Specific
Ability to interpret medical, accident, and legal documents relevant to insurance claims.
In-depth knowledge of insurance policies, claims procedures, and legal regulations.
Knowledge of compliance with Malaysian insurance laws and industry standards.
Negotiation skills for settling claims effectively.
Proficiency in claims investigation and fraud detection techniques.
Proficiency with claims management systems and relevant software.
Risk assessment to evaluate potential losses and liabilities.
Additional Info
QUALIFICATION
Diploma or equivalent
Related Courses
Claimable Course
e-Latih Online Course
Madani TVET Course
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