Claims Executive

5 months ago


Kuala Lumpur, Malaysia Prudential plc Full time

Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow and Succeed.

Validate the information stated in the Pre-Authorization Form completed by the client and attending doctor, assess the request, calculate the correct amount coverable and make a correct decision accordance to benefit terms & Claims SOP.

Ascertain the accurate data entry such as ICD10 Diagnosis Code, Surgery and Consultation Code (per PHA Schedule) and items charged per bills issued by hospital.

Process Pre-Authorization Letter request within the agreed Service Level accordance to daily productivity target.

Participate in product and technical trainings as well as work with supervisor for additional training plans in acquiring and improving industry or technical knowledge.

Ensures compliance with all regulatory (internal and external) and corporate requirements.

Manage customer /agents/ hospitals complaints or enquiries and provide feedback/response appropriately.

Any other tasks given by HR, company or department activities/directives as well as Ad-hoc function as requested by Section Head or HOD



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