Executive, Healthcare 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 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.

KEY RESPONSIBILITIES:

• Assess claims fairly and make decisions according to policy terms and conditions.

• Approve claims within the department’s benchmark, turnaround time, and authority limit.

• Recommend claims for approval or repudiation, where required.

• Ensure customer enquiries from all referral sources are attended to promptly and resolved through the appropriate communication channels.

• Monitor claims processing benchmarks and turnaround time.

• Handle daily department correspondence and coordinate with other departments when needed.

• Handle enquiries from internal and external parties via email and incoming enquiries.

• Support outbound calls to customers and agents for declined claims.

• Liaise with Prudential Malaysia’s IT division to troubleshoot operational system issues or cases.

• Review, update, and document administrative rules and processes to ensure smooth and efficient operations.

• Attend training to support personal and career development.

• Undertake projects, tasks, or other duties assigned by management from time to time.

QUALIFICATIONS & REQUIREMENTS:

•  Bachelor's Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration, or a related field.

 

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.