Executive, Customer Promise - Medical Reimbursement & Accident

Overview

Executive, Customer Promise - Medical Reimbursement & Accident

Join to apply for the Executive, Customer Promise - Medical Reimbursement & Accident role at Prudential Assurance Malaysia Berhad

Job Summary

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.

Principal Duties & 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 or complaint 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 insurance companies 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

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.

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