Claims Administrator

1 day ago

Kuala Lumpur, Malaysia Prudential plc Full time

Claims Administrator

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.

In this role, you will review, assess and approve group insurance claims within service turnaround time. As part of this dynamic role, you will report to Team Lead, Enterprise Business Operations and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirements.
- Adjudicate Health and 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, 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.
- 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.

Who we are looking for:
Competencies & Personal Traits
- Strong command of the English language (spoken and written)
- Familiarity with human anatomy, general diseases and disease management

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

Education
- Diploma or Degree

Language
- English

Job ID 23080453

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