Executive, 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.

Job Profile Summary:
In this role, you will provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.

Job Description:

- Adjudicate group outpatient medical claims and ensure delivery of prudent and equitable claims decision within expected service level (i.e. claims turnaround time).
- Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
- Review workflow and claims processes to identify areas of improvement and implement enhancement to achieve efficient claims administration.
- Work closely with underwriters and other business units to ensure that claims are processed accurately and that all service level agreements are met.
- Manage working relation with external parties - Central Provident Fund Board (CPFB), regulator, financial consultants, bancassurance partners, medical institutions, TPAs, etc.
- Manage investigation of claims by working with claims adjusters, legal advisors, medical institutions, claimants, financial consultants, and other insurers to determine claims decision and payment.
- Manage enquiries, service recovery, complaints and appeal arising from claims.
- Follow up with claimants and medical institutions on any outstanding requirements required for claims adjudication through documented follow-up process and provide regular update on claims status.
- Any other ad-hoc assignment assigned.

Who we are looking for:
Competencies & Personal Traits
- Strong command of the English language (spoken and written)
- Conflict resolution and relationship management skills
- Excellent communication, interpersonal and problem-solving skills
- Customer-centric with ability to work under pressure
- Self-motivated and independent
- Team player

Working Experience
- 2 to 3 years of working experience in medical claims processing

Education
- Diploma holder

Language
- English

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