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Senior Executive, Claims role in Kuala Lumpur offering opportunity to manage health claims and drive service excellence.
Apply your expertise in claims adjudication, regulatory compliance, and customer service within a leading insurance company.
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.
ROLE PURPOSE:
- • Provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.
ROLE DUTIES & RESPONSIBILITIES:
- • Adjudicate Accident & Health (A&H) claims and ensure delivery of prudent and equitable claims decision within expected service level.
- • Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
- • Manage claims investigation by working with claimants, financial consultants, medical institutions, insurers, etc to determine claims decision and payment.
- • Follow up on outstanding requirements needed for claims adjudication through documented follow-up process and provide regular update on claims status.
- • Work closely with other business units to ensure that claims are processed accurately and that all service level agreements are met.
- • Manage enquiries and appeals arising from claims.
KEY PERFORMANCE INDICATORS:
- • Ensuring that the claims are processed within the expected service level;
- • Attaining the benchmarked targets for productivity, claims pending rate, suspense management rate
Additional Job Description
Competencies & Personal Traits
- • Excellent communication, interpersonal and problem-solving skills with ability to investigate, evaluate and reach an appropriate decision
- • Customer-centric with ability to work under pressure
- • Self-motivated and able to work independently
- • Team player, mature, with excellent leadership quality.
- • Good medical knowledge and claims settlement procedure.
- • Ability to read basic Chinese will be advantageous
Working Experience
- • At least 1-2 years of experience as a Life & Health claims assessor
Language
- • Strong command of English language
- • Basic Chinese will be advantageous
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.