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Senior Executive, Claims

Senior Executive, Claims

Prudential plcKuala Lumpur
18 days ago
Job description

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.

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. As part of this dynamic role, you will report to the Team Lead, Claims and work closely with internal and external stakeholders to fulfil our Claim Promise to customers and ensure the accuracy and compliance to internal policies and external regulatory requirements.

A&H Claims Assessor (E / SE Role)

Justification

To fulfill our Claim Promise to customers

Job Description Summary

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.

Job Description

ROLE DUTIES & RESPONSIBILITIES :

This role is accountable and responsible for the following :

  • 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 :

    Improving the customer's Instant experiences on claims by :

  • 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
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    Senior Executive • Kuala Lumpur