Manager, Major Claims

1 week ago

Kuala Lumpur, Malaysia Prudential plc Full time

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.

The Manager, (Major Claims) provides knowledge of products coverage functionalities or technicalities and operational processes to ensure good assessment and management of risks. The incumbent also administered the efficiency of daily claims operations and deliverance by Claim Department towards service excellence. Managed and overseeing Technical Development for product implementation, business strategies and ability to work with Panel/ Consultant for clinical/ technology assessment to align with industrial practice. Handling all types of claim enquiries including but not limited to agent/ customer/ legal/ BNM/ OFS. The incumbent also acted as interdepartmental liaison for Claims Committee Meeting (CCM), Product Implementation Committee (PIC), Business Alignment Committee (BAC) & Risk Coordinator (RC).

Job Description:

- 1. _To lead and manage Major Claims Operation Team:

- Ensure all claims are assessed in accordance with SOP and claims guideline for claim process by team.
- Accountable on team efficiency and effectiveness performance on TAT, productivities per level set.
- To measure the quality and individual error management in the team in order to categorize the training needs.
- Manage and perform claims assessment and approval on all claims based on authority limit for the whole team.
- Accountability in staff development by providing internal training plan or refresher training and continuously giving technical advice, leadership and motivation whenever required.
- To monitor and review work systems and processes for the effective and efficient operations and implementing process improvements where appropriate.
- Ensures section/unit complies with all regulatory (internal and external) and corporate requirements. To work closely with Risk, Compliance, Shariah, Actuarial and others operation department.
- Responsible in claims control management in reviewing and analyzing on daily, monthly and ad-hoc statistic & claims trends analysis for reporting to management.
- Working with other stakeholders in managing loss ratio and achieved substantial savings upon effective monitoring and subsequently proactive actions in dealing with fraud claims, non-disclosure, claims under agent’s or doctors watchlist/ frequent claims.
- Participate in roadshow, claims clinic and workshop
- Established strong relationship with business partner, retakaful operator, legal, panel hospital and others insurer.

2. Assisting Section Head as the Interdepartmental liaison:
a) Claims Committee Meeting (CCM)
- Initiated and organized Claims Committee Meeting at least once per quarter
- Presentation to CCM on cases/ items which required CCM notation/ deliberation/ approval
- Prepare meeting minutes to be endorsed & signoff by Chairman
- Review and revised CCM TOR whenever required
- Ensure all matters aligned with CCM TOR

b) Product Implementation Committee (PIC)
- Attend PIC meeting weekly
- Design, develop and implement new product till go live.
- Enhance existing product specification/ features to meet customer expectation & align industrial practice

c) Business Alignment Committee (BAC)
- Attend BAC meeting weekly to discuss operation process to align with PAMB.
- Review & implement the change of process flow to operation.

d) Jariyah Fund Committee (JFC)
- Attend JFC meeting every half yearly to have latest updates on Jariyah Fund development.
- To monitor & report on all matter related to microtakaful claims

Qualification and Experience:

- Tertiary education in any field. Preferred field: Biomedical/Biotechnology/Bioscience/Business Administration/Mathematics/Economics
- Experience: 8 years in Claims operations with managerial skills
- Passing Professional Examinations: Life insurance qualification eg. ACII, AMII, AAII, FLMI. is an advantage

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