Healthcare Claims Executive null

Job Overview

At Prudential, we understand that success comes from the talent and commitment of our people. Together, we have a shared vision in securing the future of our customers and our communities. We strive to build a business that you can shape, an inclusive workplace where everyone’s ideas are valued and a culture where we can thrive together. Our people stay connected and tuned in to what’s happening around us, keeping us ahead of the curve. While focused on the long-term, 

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 claims 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.

Responsibilities

• Adhering to our claim workflow in relation to 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
• Ensuring customers enquiry from all source of referrals are promptly attended to and resolves via appropriate communication mode.
• To ensure and monitor claims processing benchmark and turnaround time
• To correspondences on and day to day operation functions of the department and coordinates with other departments
• To handle incoming enquiries from internal or external parties via emails, phone calls and portal.
• Updating and submission of 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 section.
• Continuously attend / involve with training for personal and career development.
• Undertake projects / other work and duties allocated by Management, as and when required
• Ensuring that Financial Services Act (FSA), Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.

Requirements

• Degree in Biomedical Science, Allied Health or Biology, Mathematics, Economics, Statistics, Business Administration, and etc.
• Experience
• Preferably experience in HealthCare, financial institutions, i.e. Banks, Insurance for at least 1 Year.
• Fresh graduate can be considered.
• Knowledge            
• Life Insurance background, preferably in Health, Accidental & or Life Claims.