PBTB | Head of 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.

The HOD has the key responsibility in providing leadership to end-to-end claims process for both individual policies and employee group benefit claims, including pay and file, cashless guarantee letter admissions, team production and claims investigations, projects and streamlining / automation of processes. This role requires a strategic leader with a deep understanding of insurance claims management, exceptional operational skills, and the ability to drive efficiency and customer satisfaction in claims processing.

Job Description :

• Oversee the processing of medical and life insurance claims for individual policies and employee group benefits.
• Ensure productivity timely and accurate processing of pay and file claims and cashless guarantee letter admissions
• Develop and implement claims management strategies to improve efficiency and customer satisfaction.
• Develop and maintain staff rosters ensuring optimal coverage and compliance with labor laws.
• Fraud Investigations are carried out timely and accordingly.
• Lead and manage the claims operations team, including claims processors, investigators, and support staff.
• Provide training, mentorship, and performance evaluations to team members.
• Foster a collaborative and high-performance work environment.
• Streamline claims processing workflows to enhance productivity and reduce turnaround times.
• Implement best practices and continuous improvement initiatives in claims operations.
• Monitor key performance indicators (KPIs) and ensure compliance with regulatory requirements.
• Ensure a customer-centric approach in all claims handling processes.
• Address and resolve escalated claims issues and customer complaints.
• Collaborate with customer service teams to enhance the overall customer experience.
• Collaborate with internal and external stakeholders, including underwriters, brokers, and healthcare providers.
• Maintain strong relationships with key partners to facilitate smooth claims processing.
• Represent the claims department in meetings and industry forums.
• Prepare and present regular reports on claims performance, trends, and areas for improvement.
• Utilize data analytics to drive decision-making and strategic planning.
• Ensure accurate and timely reporting to senior management.
• Manage the claims budget and ensure cost-effective operations

Qualification and Experience :