Executive, Customer Promise - Medical Reimbursement & Accident

Responsibilities

• Adhering to the claims workflow in relation to Accident and Hospitalization claims procedure.
• Assess and provide justifiable claims according to policy terms and conditions, within the department benchmark, turnaround time and authority limit.
• Ensure claims appeal, referral orplaint from any parties are attended to and respond within the benchmark set by the department.
• Ensure and monitor claims processing to be within the department benchmark and turnaround time.
• Closely follow up on outstanding cases.
• Attend to & handle enquiries from internal staff, branch staff, agents, policyholders / claimants and queries from other insurancepanies and ensure the respond within the benchmark set by the department.
• Correspond both internally and externally (inclusive but not limited to agents, policyholders, employer, private investigator, FMB and BNM) in order to handle day to day operation functions of the department, and coordinate with other departments, where applicable.
• Record, update, review, prepare and submission of statistics or reports, as required by the Management within the agreed service standards.
• Continuously review processes, identify and resolve any gaps through constructive feedback, and implement process improvement, where appropriate; update / document the administrative rules and processes for effective and efficient operation of the section.
• Continuously attend and involve with training for personal and career development.
• Conduct internal & external training in claims related matters, as and when required.
• Undertake projects or any other work and duties allocated by the Management or involve in Claims Department matters, as and when required.

REQUIREMENTS :

Qualification : Degree in Biomedical Science / Biology / Mathematics / Economics / Statistics, Business Administration and etc. Professional life insurance qualification, ACII, AMII, AAII, FLMI would be an added advantage.

Experience : Fresh Graduate (for Executive) or

Claims Handling, 3 to 5 years in Life Insurance industry (for Assistant Manager)

KSA's : Goodmand of English and Bahasa Malaysia.

Must have minimal insurance knowledge (for Executive)

Equipped with insurance knowledge & technical know-how on the fundamentals of Insurance, Accidental & Medical business acumen (for Assistant Manager)

Able to work independently and have goodmunication skills

Must be IT literate

KSA's - Knowledge, Skills & Ability)

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. Job ID 25050514