Báo cáo thành công

• Claims intake & registration: receive and register claim notifications from drivers, passengers, or beneficiaries; verify claim eligibility against trip data, policy coverage, and the group policy schedule.
• Trip & documentation validation: cross-check claim details to confirm the incident occurred within a covered trip; review supporting documents (death certificates, police reports, medical/hospital reports, identification) for completeness, consistency, and authenticity.
• Claims assessment & adjudication: assess claim merits against policy terms and the TPD/PPD benefit table, calculate benefit amounts and any applicable deductions, and recommend approval, decline, or repudiation within delegated authority limits, escalating complex or high-value cases to the Head of Operations.
• Investigation & fraud control: identify and investigate contestable, early, large, or suspicious claims – including trip/claim mismatches or disputed circumstances – coordinating with partner, medical officers, or external investigators, and escalating potential fraud, non-disclosure, or misrepresentation.
• Claimant & beneficiary communication: communicate claim decisions clearly and empathetically to claimants and beneficiaries; manage related inquiries, complaints, and appeals.
• Claims systems & records: process and record claims in the system, maintaining accurate claim files, benefit calculations, and audit trails; support UAT and configuration testing for claims-related system builds (e.g., TPD/PPD benefit tables, claims workflows).
• Regulatory & TAT compliance: ensure all claims are processed within IRC-mandated and internal turnaround times, maintain documentation to support IRC claims reporting, and flag AML/CFT-related concerns in line with the company’s AML/CFT/CPFPWMD policy.
• Reporting & continuous improvement: prepare claims experience reports (volumes, TAT, loss ratios, rejection reasons) for management review, and recommend product or process improvements based on observed claims trends.

Education & Experience

• Bachelor’s degree in Finance, Business Administration, Law, or a related field.
• 2+ years of experience in life/group insurance claims processing, accident or health claims, or a related insurance operations role; experience with embedded insurance, bancassurance, or digital/platform-distributed products is an advantage.
• Professional insurance qualification (e.g., LOMA – FLMI/ALMI) is preferred.

Skills & Competencies

• Strong analytical skills and sound, evidence-based decision-making, with high attention to detail.
• Excellent communication and interpersonal skills, with empathy and a customer-centric approach; comfortable liaising with an external distribution partner.
• Working knowledge of Cambodian insurance regulatory requirements or strong willingness and ability to learn quickly.
• High level of integrity and discretion in handling confidential and sensitive information.
• Comfortable working within core insurance systems and MS Excel for claims tracking, calculation, and reporting.
• Ability to work under pressure, manage multiple concurrent cases, and meet deadlines in a fast-moving startup environment.
• Proficiency in Khmer and good working English.