Executive, Claims

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

Working Experience

Education

Language