Executive, Claims

2 weeks ago

Kuala Lumpur, Kuala Lumpur, Malaysia Prudential Group Full time
Executive, Claims (Medical Reimbursement & Accident)

JOB SCOPE:
The incumbent is responsible to provide efficient and effective support to the Company goals by meeting and exceeding their expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer's enquiries are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.

Position Summary:
Claims Examination
Claims Recommendation
Claims Approval within authority limit

PRINCIPAL DUTIES & RESPONSIBILITIES:

  1. Adhering to our claims workflow in relation to accident and hospitalization claims procedure
  2. Assess and provide justifiable claims according to policy terms and conditions to our valued policy holders
  3. Approving claims within the department benchmark/turnaround time and authority limit
  4. Recommend for claim approval/repudiation
  5. To ensure claims appeal from any parties are attended and respond within the benchmark set by the department
  6. To ensure and monitor claims processing benchmark and turnaround time
  7. To closely follow up on outstanding cases
  8. To correspondences on and day to day operation functions of the department and coordinates with other departments
  9. To handle queries from other insurance companies via ICVS and ensure the respond within the benchmark set by ISM
  10. To prepare correspondences both internally (sales advisor and other departments) and externally (policyholders, employer, private investigator, FMB/BNM and repudiation letter)
  11. To handle incoming enquiries from internal or external parties via emails, phone calls, letter and walk in customers
  12. Updating and submission of reports as required by management within the agreed service standards
  13. Liaise with Prudential Malaysia's IT division to troubleshoot issues / cases encountered in the day to day operations
  14. Continuously review and update/document the administrative rules and processes for effective and efficient operation of the sections
  15. Continuously attend / involve with training for personal and career development
  16. Undertake projects / other work and duties allocated by management as and when required

REQUIREMENTS:

  • Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration, etc.
  • Fresh Graduate or Claims Handling, i.e. 3 to 5 years in the insurance industry / Life Insurance industry (a MUST for Major Claims)
  • Good command of English and Bahasa Malaysia
  • Must have minimal insurance knowledge
  • Able to work and have good communication skills
  • Must be IT literate

A rewarding and fulfilling career awaits you at Prudential. We believe in making a difference through the power of listening, striving to build brighter futures for our customers, employees, and society.

As a leading provider of financial solutions in Asia, Prudential offers ample opportunities for you to succeed and expand your career horizons.

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