company-logo-image

PACS | Ops - EBO Claims - Senior Executive

ashley-avatar-image

AI-generated summary

beta

This job is a Senior Executive in EBO Claims at Prudential, adjudicating health and medical insurance claims while ensuring compliance and efficient claims administration. You might like this job because it offers the opportunity to work on diverse tasks, manage external relationships, and contribute to making impactful claims decisions within service level agreements.

Undisclosed

Kuala Lumpur (Group Head Office), 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.

In this role, you will review, assess and approve group insurance claims within service turnaround time. As part of this dynamic role, you will report to Team Lead, Enterprise Business Operations and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirements.

   Adjudicate Health and medical claims and ensure delivery of prudent and equitable claims decision within expected service level (i.e. claims turnaround time).

-   Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.

-   Review workflow and claims processes to identify areas of improvement and implement enhancement to achieve efficient claims administration.

-   Work closely with underwriters and other business units to ensure that claims are processed accurately and that all service level agreements are met.

-   Manage working relation with external parties – Central Provident Fund Board (CPFB), regulator, financial consultants, bancassurance partners, medical institutions, etc.

-   Manage investigation of claims by working with claims adjusters, legal advisors, medical institutions, claimants, financial consultants, and other insurers to determine claims decision and payment.

-   Manage enquiries, service recovery, complaints and appeal arising from claims.

-   Follow up with claimants and medical institutions on any outstanding requirements required for claims adjudication through documented follow-up process and provide regular update on claims status.


Who we are looking for:
Competencies & Personal Traits
• Strong command of the English language (spoken and written)
• Familiarity with human anatomy, general diseases and disease management

Working Experience
  2 to 3 years of working experience in medical claims processing


Education
• Diploma or Degree

Language
• English

 

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