PBTB | Executive, Claims

2 days ago

Kuala Lumpur, Kuala Lumpur, Malaysia Prudential plc Full time 120,000 - 200,000 per year

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.

1. Assisting in daily operation including PAL issuance
2. Monitor the technical and operational development of staff and Quality performance within the section.
3. Assist HOU in Managing the HAS portfolio including monitoring the HAS team daily productivity and managing issues, duty roster, work with Agency and Panel hospital and giving right feedback in appointment and monitoring of panel hospitals.
4. Ensure the online request is work within benefit specification, calculation work within agree fee schedule per regulatory, utilization is within agree charges with panel.
5. Supervise call team in daily operation, ensure on overall team efficiency and quality
6. Monitors call team performance and quality achievements

7. Assist HOU in continue monitoring and updating of MMA codes, schedule of fees, communicate with Dr/panel on vague and discrepant charges.
8. Work with technical consultant to provide training to the team regularly to upgrade their knowledge via classroom structure knowledge program, case study and etc.
9. Oversee CUR team ensure on overall quality & TAT

10. Manage customer (clients, panel, agency and etc) complaints/enquiries through CSM, e-mail or written complaint and provide feedback/response within 24 hours.

11. Monitor and review work system, projects, and processes to ensure effective and efficient operations of HAS and implementing process improvements where appropriate. Ensure all projects are work and deliver within timeline
12. Prepared and deliver all daily, weekly, monthly, and quarterly or year statistic, analysis for reporting to management

13. Perform any Ad-hoc function as requested by Section Head or HOD
14. Participate in roadshow, claims clinic and workshop as and when required

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.

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