Executive, Claims

Prudential

  • Kuala Lumpur
  • Permanent
  • Full-time
  • 2 months ago
Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.Job Profile Summary:In this role, you will provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.Job Description:
  • Adjudicate group outpatient medical claims and ensure delivery of prudent and equitable claims decision within expected service level (i.e. claims turnaround time).
  • Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
  • Review workflow and claims processes to identify areas of improvement and implement enhancement to achieve efficient claims administration.
  • Work closely with underwriters and other business units to ensure that claims are processed accurately and that all service level agreements are met.
  • Manage working relation with external parties – Central Provident Fund Board (CPFB), regulator, financial consultants, bancassurance partners, medical institutions, TPAs, etc.
  • Manage investigation of claims by working with claims adjusters, legal advisors, medical institutions, claimants, financial consultants, and other insurers to determine claims decision and payment.
  • Manage enquiries, service recovery, complaints and appeal arising from claims.
  • Follow up with claimants and medical institutions on any outstanding requirements required for claims adjudication through documented follow-up process and provide regular update on claims status.
  • Any other ad-hoc assignment assigned.
Who we are looking for:Competencies & Personal Traits
  • Strong command of the English language (spoken and written)
  • Conflict resolution and relationship management skills
  • Excellent communication, interpersonal and problem-solving skills
  • Customer-centric with ability to work under pressure
  • Self-motivated and independent
  • Team player
Working Experience
  • 2 to 3 years of working experience in medical claims processing
Education
  • Diploma holder
Language
  • English
Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.

Prudential