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Join Prudential in Kuala Lumpur as an Employee Benefits Claims specialist.
Excel in claims processing and customer service at a leading insurer.
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 Description
Adjudicate G roup Major Claims ( Death, TPD, Critical Illness, Disabili ty, Terminal Illness, etc ) and Group Medical Claims ( Hospital & Surgical, Major Medical, Outpatient Specialist , Outpatient Clinical, Dental, etc ) 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. 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), 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.
Competencies & Personal Traits
- Detail-oriented with a commitment to accuracy and quality.
- Innovative and resilient with a strong eye for detail
- Excellent communication skills in English, both written and verbal
- Conflict resolution and relationship management 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 both life and medical claims processing
Education
Diploma or Degree
Language
English
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.