company-logo-image

Manager, Claims Technical Excellence

ashley-avatar-image

AI-generated summary

beta

This job is managing a team to detect fraud in medical claims and improve processes at Prudential. You might like this job because you'll help prevent fraud and ensure quality service for customers.

Undisclosed

Kuala Lumpur

Job Description

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 of Medical Claims Fraud, Waste and Abuse (FWA) detection and Claims Avoidance Rate in Prudential to ensuring long-term sustainability of portfolio. With strong knowledge in medical and Insurance processes, the incumbent will perform training and audit, maintain system rules and guidelines to equipe Claims Department to have the capability in eliminate leakages.

Performing the role as a lead in managing staff and to ensure task assigned to team member complete within given time to meet expectations on operational processes.

Assist the Senior Manager to lead and coordinating the team members to achieve the company’s goal in providing support and guidance to Claims Department via assessor knowledge, guidelines, systems, technology, etc.

To support and provide analysis to internal stake holder in monitoring effectiveness and detect gaps to develop new initiatives and measures to achieve the goal.

Manage & provide claims training for claims assessors to ensure skills are continuously improved through external trainings or customized technical training program.

Provide and support claims training to other departments or business partners. 

Manage and perform claims review on claims assessor’ cases as part of claims authority upgrade process.

Manage and report on claims/compliance audits to ensure quality assessment and compliance is achieved and identify any improvement areas.

Perform regular review of underwriting guidelines to ensure that it is relevant, competitive and to drive operational efficiency while maintaining good risk management and long-term sustainability of Portfolio.

To work closely with other departments and vendors in delivering robust Claims process flow.

Develop and maintain rules in the claims system for STP and identify opportunities that provide operational efficiency, support business growth and seamless customer experience.

Leverage on internal & external data to understand current state, trend and opportunities in improvement/growth area.

Support improvement in SLA and minimizing penders through identifying improvement opportunities, automation, streamlining processes & guidelines.

Support improvement in onboarding NPS through various initiatives, manage and monitor the team performance in meeting departmental service expectations and deliver excellent service quality to customer.      

Participate in Roadshows, Quality leaders meeting and focus group dialog to gain insight and provide education on Medical Claims and FWA.

 

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.


Job Requirements


Company Benefits

United through teamwork

Our teams are innovative, hands-on and collaborative. The power to share and collaborate requires respect, integrity and teamwork.

Open and collaborative culture

Our company is rooted in a rich heritage but to look to the future, we need new energy and perspectives.

Connect, Grow, Succeed

We are here to help our employees expand their skills and expertise in various areas.


Additional Info

Company Activity

Last active - few hours ago


Company Profile

Prudential plc-logo-image

Prudential plc

Prudential Assurance Malaysia Berhad (PAMB) is a leading and innovative insurance company in Malaysia, serving the savings, protection and investment needs of Malaysians by offering a full range of financial solutions through its branches, agency force and bancassurance distribution partners network nationwide. 

Our purpose For Every Life, For Every Future is to provide simple and accessible financial and health solutions to every generation.

PAMB was established in Malaysia in 1924 and is a subsidiary of Prudential plc, which was founded in London in 1848. Prudential plc provides life and health insurance and asset management, with a focus on Asia and Africa.

This year, we are proud to celebrate Prudential’s 100th anniversary in Malaysia.

Source: prudential.com