Executive, Customer Promise - Major Claims

Overview

Executive, Customer Promise - Major Claims at Prudential Assurance Malaysia Berhad. The role provides efficient and effective support to company goals by meeting and exceeding expectations on operational processes. The incumbent must acquire knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer inquiries are resolved in accordance with agreed service levels, and work closely with other operations departments to deliver excellent service quality to customers.

Responsibilities

• Adhere to the claims workflow in relation to major, accident and hospitalization claims procedures
• Assess and provide justifiable claims according to policy terms and conditions to policyholders
• Approve claims within department benchmark / turnaround time and authority limit
• Recommend for claim approval or repudiation
• Ensure claims appeals from any parties are attended and respond within the department benchmark
• Monitor claims processing benchmarks and turnaround times
• Follow up on outstanding cases
• Correspond on day-to-day operation functions of the department and coordinate with other departments
• Handle queries from other insurance companies via ICVS and respond within ISM benchmarks
• Prepare correspondences internally (sales advisors and other departments) and externally (policyholders, employers, private investigators, etc.) including repudiation letters
• Handle incoming inquiries from internal or external parties via email, phone, letters, and walk-in customers
• Update and submit reports as required by management within service standards
• Liaise with Prudential Malaysia’s IT division to troubleshoot day-to-day issues
• Review and update / document administrative rules and processes for effective operation
• Attend training for personal and career development
• Review and provide opinions from medical perspectives (e.g., medical conditions, treatments, contract conformity)
• Undertake projects and other duties as allocated by management

Qualifications

Education : Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration, etc.

Experience : Fresh graduate or Claims handling experience; 3–5 years in the insurance industry / Life Insurance industry (required for Major Claims)

KSA (Knowledge, Skills & Abilities) : Good command of English and Bahasa Malaysia; basic insurance knowledge; ability to work and communicate well; IT literate

Prudential is an equal opportunity employer. We provide equal opportunity of benefits for all applicants and employees regardless of sex, race, age, ethnic origin, education, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability, or any other status protected by applicable law. Reasonable adjustments are available to support individuals with health requirements.

Job details

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