JUN ROU LEE
Insurance Claims
Kuala Lumpur,14
Summary
Ensure the team meets departmental SLAs, supports the reduction of department-wide errors, and enhances overall team productivity. Aim to reduce unnecessary delays for a better customer experience. Actively seek innovations in systems or process improvements to streamline daily operations and boost overall team efficiency. Regularly review claims guidelines to enhance customer experience. Reduce staff attrition by maintaining regular communication with team members to improve engagement.
Overview
12
12
years of professional experience
4
4
Certifications
Work History
MANAGER OF MEDICAL CLAIMS
EUROP ASSISTANCE
Petaling Jaya, Selangor
02.2022 - Current
- Assess and approve inpatient and outpatient claims that exceed the authority of team members for Hong Kong, Macau, and China (Chinese-based territories)
- Address complex cases, such as appeals or complaints reported by clients, by investigating any lapses in service. Provide a chronology of events and a remedial action plan if needed.
- Liaise with clients regularly to ensure mutual alignment on matters such as SLA, claims practices, and client requirements. Provide guidance to team leaders on daily management issues, identify successors with development planning, and offer coaching.
- Provide guidance to team leaders on daily management issues, identify successors with development planning, and offer coaching.
- Conduct coaching sessions and individual conversations with team members to guide them in achieving department SLAs and their own personal development.
- Liaise with the IT or facilities team when the team encounters system or facilities issues.
- Liaise with the Digital Innovation Team (DTI) to provide ideas for system enhancements and share user experiences and feedback. Additionally, work closely with the DTI team on new product setup and address client requests for system enhancements.
- Monitor the daily operations of both the admin and claims teams to ensure that SLAs are achieved.
- Regularly meet with Team Leaders to review audit results, analyze team performance based on these results, and discuss remedial or improvement plans to enhance overall team performance.
- Share updates on claim practice changes and management messages with the team from time to time.
ASSITANT MANAGER OF MEDICAL CLAIMS
AIA SHARED SERVICES
Cyberjaya, Selangor
04.2013 - 01.2022
- Assess and approve accident and hospitalization claims that exceed the authority of team members for Hong Kong, Macau, and China (Chinese-based territories).
- Handle complex cases, such as appeals or potential complaints reported by Hong Kong business partners.
- Review the monthly audit report, analyze the results and findings to understand the root causes, and implement an action plan to improve the overall quality of team members.
- Conduct pending reviews to minimize unnecessary delays caused by junior staff and enhance the customer experience.
- Liaise and meet regularly with the Hong Kong business partner to ensure alignment of claims practices and company direction between the Hong Kong and Malaysia teams.
- Provide guidance to junior team leaders on daily management issues.
- Conduct classroom training for new joiners.
LOAN DOCUMENTATION ASSISTANT
SERI PAJAM DEVELOPMENT SDN BHD
Nilai, Negeri Sembilan
09.2012 - 04.2013
- Ensure the accuracy of details in housing purchase documents, such as the Sale and Purchase Agreement (SPA) and legal contracts.
- Contact clients to obtain missing information or address their queries.
- Liaise with banks and solicitors to ensure that the purchasing process proceeds smoothly and on time.
- Maintain and update sales and customer records regularly.
- Support company launch events by providing guidance and assistance to customers.
MEDICAL CLAIMS ASSOCIATE
AIA SHARED SERVICES
Cyberjaya, Selangor
4 2011 - 7 2012
- Assess accident claims for Hong Kong, Macau, and China (Chinese-based territories) daily to provide quality service to clients and reduce fraudulent cases.
- Implement claims controls to enhance the affordability and quality of health services.
- Ensure that all daily assigned cases are completed on time.
Education
Diploma in Business Studies/Administration/Management - Banking And Financial Support Services
KOLEJ TUNKU ABDUL RAHMAN
Kuala Lumpur, Malaysia 01.2008 -
Bachelor's Degree in Business Studies/Administration/Management - Banking And Financial Support Services
UNIVERSITY TUNKU ABDUL RAHMAN (UTAR)
Kampar, Perak, Malaysia 01.2011 -
Skills
Medical Claims Assessment
Insurance Operation Knowledge
Chinese-territory Insurance Operation
Medical Knowledge
Medical Bill Interpretation
Insurance Contract Interpretation
Fraud and anti-selection analytical skills
People management and communication skills
Proficiency in Chinese and English Language
Certification
LOMA CERTIFICATION Level 1
Accomplishments
- Supervised team of 20 staff members.
- Participated in the offsite Close File Review Project conducted by the group and promoted the importance of the project by providing training sessions to the team.
- Completed the COACH MASTER ACADEMY – PERFORMANCE COACH program in 2020.
- Completed the LEADERSHIP PROGRAM LEVEL 2 – LEADING OTHERS in 2023.
Timeline
2023 LEADERSHIP PROGRAM LEVEL 2 - LEADING OTHERS
08-2023
SMART WORKING WORKSHOP
07-2022
MANAGER OF MEDICAL CLAIMS
EUROP ASSISTANCE
02.2022 - Current
COACH MASTER ACADEMY - PERFORMANCE COACH
11-2020
ASSITANT MANAGER OF MEDICAL CLAIMS
AIA SHARED SERVICES
04.2013 - 01.2022
LOAN DOCUMENTATION ASSISTANT
SERI PAJAM DEVELOPMENT SDN BHD
09.2012 - 04.2013
LOMA CERTIFICATION Level 1
11-2011
Bachelor's Degree in Business Studies/Administration/Management - Banking And Financial Support Services
UNIVERSITY TUNKU ABDUL RAHMAN (UTAR)
01.2011 -
Diploma in Business Studies/Administration/Management - Banking And Financial Support Services
KOLEJ TUNKU ABDUL RAHMAN
01.2008 -
MEDICAL CLAIMS ASSOCIATE
AIA SHARED SERVICES
4 2011 - 7 2012
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