Manager, Customer Promise – Healthcare Claims

3 days ago

Kuala Lumpur, Kuala Lumpur, Malaysia Prudential Hong Kong Limited Full time
Manager, Customer Promise – Healthcare Claims

Apply locations Kuala Lumpur time type Full time posted on Posted 7 Days Ago job requisition id 25010021

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.

PRINCIPAL DUTIES & RESPONSIBILITIES:

  1. Responsible for daily work and ensuring that the daily operations with good analysis on impact and act strategically in optimizing the operation capacity to meet the business goal set forth as the service standard level.
  2. Analyze staff's productivity daily and compilation in staff's monthly productivity, review & reports with constructive feedback, and implement action plans by identifying underlying course to improvements where appropriate.
  3. Makes good & sound decision during uncertain and difficult context to minimize the disruption on operation and continuously review processes, identify and resolve service gaps through constructive feedback, and implement process improvements where appropriate.
  4. Ensuring all claim examiners in the Healthcare Claims unit meets all type of service standards (benchmark and TAT) each month.
  5. Provide justification for not meeting the monthly service standard.
  6. Analyze cause of problem affecting processing and recommend alternative solution.
  7. Ensuring justifiable decision on hospitalization claims within Turnaround time.
  8. To process claim with recommendation for settlement and approval within the department benchmark.
  9. To handle queries from agents and insured and prospect customers via phone calls, faxes and e-mails.
  10. To correspondences on and day to day operation functions of the department and coordinates with other departments.
  11. Claims appeal from insured and agent to be attended and respond within the benchmark set by the department.
  12. Responsible in relation to customer's enquiry in order to maintain a high level of quality service to customer and record, produce and prepare any statistics and information required by the Management in relation to the customer enquiry and progress.
  13. Monitoring and analyzed the occurrences of incidences on the occurrences required with simple performance-based reports of individual staffs identified and log in the action plan, progress of the action taken inclusive monetary recovery and coverage based on ex-gratia on the occurrences filed.
  14. Responsible for staff's development in training and re-training as and when required by identifying the base line of staff's assessment skills and the reports of occurrences in staff's assessment skills.
  15. To conduct workshops with agency force in training technical understanding of product from the aspect of Claims (HAS Facility)
  16. Performance miscellaneous job-related duties and projects assigned by superior.

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.

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