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Executive Risk Investigator
1 week ago
As an Investigation Specialist at Prudential, you will play a critical role in ensuring that our customers receive fair and timely resolution of their claims.
You will be responsible for investigating and resolving complex claims, working closely with our Underwriting, Endorsement, and Compliance teams to ensure that all relevant regulations and standards are met.
Key responsibilities include:
- To investigate and rule out suspicious/fraud claims by conducting full assessments and pursuing suspicious elements found in claimants, person covered, panel hospitals, doctors.
- Validate the information stated in the claims documents, assess and calculate the correct amount coverable and make decisions in accordance with benefit terms and Claims SOP.
Additional responsibilities include:
- To conduct field visits whenever required to gather information.
- To liaise with hospital personnel including nurses and doctors via phone-call/email/writing letters as well as agents or clients, appropriately to obtain necessary information in processing claims requests.
- Coordinate with personnel from other related departments/sections within the company, such as Risk, Shariah, Actuarial and other operational departments.
