Senior Claims Assessor
2 weeks ago
Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow and Succeed.
ROLE PURPOSE:
- Provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.
ROLE DUTIES & RESPONSIBILITIES:
This role is accountable and responsible for the following:
- Adjudicate Accident & Health (A&H) 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.
- 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.
- Coach and mentor junior staff
- Conduct claims technical workshops for agency force
KEY PERFORMANCE INDICATORS:
Improving the customer's Instant experiences on claims by:
- Ensuring that the claims are processed within the expected service level (i.e. claims turnaround time);
- Attaining the benchmarked targets for productivity, claims pending rate, suspense management rate
Competencies & Personal Traits
- Excellent communication, interpersonal and problem solving skills with ability to investigate, evaluate and reach an appropriate decision
- Customer-centric with ability to work under pressure
- Self motivated and able to work independently
- Team player, mature, with excellent leadership quality.
- Good medical knowledge and claims settlement procedure.
Working Experience
- At least 3-5 years of experience in managing claims operations
Education
- Degree with good credit in English and Mathematics
Language
- English
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