Medical Claims Consultant

Join to apply for the Medical Claims Consultant role at Prudential Assurance Company Singapore . Job Summary The position requires a qualified and experienced medical professional to support our claims teams across individual life, health, and group employee benefits lines. Responsibilities include claims assessment, adjudication, cost containment, and representation in adjudication disputes (e.g., FIDReC) and industry discussions such as Integrated Shield (PRUShield). The ideal candidate ensures integrity, fairness, and accuracy of medical claims decisions. Roles and Responsibilities Medical Evaluation & Claims Assessment Review and interpret complex medical reports, diagnostic test results, and treatment plans to assess claim validity, medical necessity, and appropriate treatment regimes relative to severity. Provide expert medical opinions on complex or high‐value claims across various products and business lines. Ensure alignment with policy definitions, exclusions, and industry best practices, supported by objective evidence. Documentation Review and Compliance Analyze submitted documentation in reference to policy definitions, exclusions clauses, and regulatory/industry standards. Ensure compliance with best practices and recommend improvements based on medical knowledge and available evidence. Stakeholder Collaboration Work closely with claims assessors, underwriters, legal, product team, and external medical providers to support decision‐making processes. Engage distributors and customers independently when complex medical advice is required to justify claims decisions. Participate in underwriting and claims committees to align medical assessment with claims guidelines and business objectives. Discuss with reinsurers, where necessary, providing expert medical insights and supporting case reviews and resolution of complex cases. Reporting & Recommendations Prepare detailed, clear, and concise case summaries with substantiated recommendations regarding claim outcomes. Provide actionable insights to improve decision‐making processes and claims evaluation efficiency. Policy Guidance & Advisory Advise on medical aspects of policy wording, including exclusions, terms, and regulatory directives. Contribute to development and enhancement of policy wording based on medical best practices. Participate in reviewing and aligning Life Insurance Association (LIA) Critical Illness definitions to ensure consistency with medical advancements and product intent. Training & Development Conduct internal training sessions to enhance medical literacy and claims evaluation skills within the claims team. Ensure the claims team stays abreast of medical advancements, treatment protocols, clinical guidelines, and regulatory changes. Continuous Improvement Contribute to process enhancements and best practices in medical claims evaluation, including cost containment, fraud prevention, avoidance, and abuse. Identify opportunities for operational efficiency and quality improvement in medical claims management. Qualifications Basic medical degree (MBBS or equivalent) from a recognized institution. Valid medical license/registration in Singapore. Work Experiences Minimum 5 years of clinical experience. Prior experience in insurance, claims assessment, or occupational health is highly desirable. Familiarity with ICD coding, medical terminology, interpretation of ECG & laboratory readings, pathology/radiology/scan reports, and insurance policy structures. Personality Traits Strong communicator with positive influence. Excellent written and verbal communication skills in English. Analytical mindset with keen attention to detail and sound ethical judgment. High level of professionalism and discretion. Capable of working independently and self‐driven. Adaptable and thrives in a dynamic work environment. Design‐focused, resourceful, and results‐driven with a hands‐on approach. Competencies / Knowledge Good understanding of the financial industry and familiarity with insurance operations. Knowledge of MOH and MAS regulations, along with industry guidelines pertinent to life & health insurance. Prudential is an equal opportunity employer. We provide equality of opportunity and 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