Executive / Assistant Manager, Claims (Medical Reimbursement & Accident)

Executive / Assistant Manager, Claims (Medical Reimbursement & Accident)

JOB SCOPE : The incumbent is responsible to provide efficient and effective support to the Company goals by meeting and exceeding their expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer’s enquiries are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.

Position Summary

Claims Examination

Claims Recommendation

Claims Approval within authority limit

Principal Duties & Responsibilities

• Adhering to our claims workflow in relation to accident and hospitalization claims procedure
• Assess and provide justifiable claims according to policy terms and conditions to our valued policy holders
• Approving claims within the department benchmark / turnaround time and authority limit
• Recommend for claim approval / repudiation
• Ensure claims appeal from any parties are attended and responded within the benchmark set by the department
• Monitor claims processing benchmark and turnaround time
• Closely follow up on out‑standing cases
• Correspond with day to day operation functions of the department and coordinate with other departments
• Handle queries from other insurance companies via ICVS and respond within the benchmark set by ISM
• Prepare correspondences both internally (sales advisor and other departments) and externally (policyholders, employer, private investigator, FMB / BNM and repudiation letter)
• Handle incoming enquiries from internal or external parties via emails, phone calls, letter and walk‑in customers
• Update and submit reports as required by management within the agreed service standards
• Liaise with Prudential Malaysia’s IT division to troubleshoot issues / cases encountered in the day‑to‑day operations
• Continuously review and update / document the administrative rules and processes for effective and efficient operation of the sections
• Continuously attend or involve with training for personal and career development
• Undertake projects / other work and duties allocated by management as and when required

Requirements

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