Claims Administrator
5 days 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.
Job Profile Summary:
In this role, you will provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.
**Job Description**:
o Adjudicate Health and medical claims and ensure delivery of prudent and equitable claims decision within expected service level (i.e. claims turnaround time).
o Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
o Review workflow and claims processes to identify areas of improvement and implement enhancement to achieve efficient claims administration.
o Work closely with underwriters and other business units to ensure that claims are processed accurately and that all service level agreements are met.
o Manage working relation with external parties - Central Provident Fund Board (CPFB), regulator, financial consultants, bancassurance partners, medical institutions, etc.
o 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.
o Manage enquiries, service recovery, complaints and appeal arising from claims.
o 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
o Strong command of the English language (spoken and written)
o Conflict resolution and relationship management skills
o Excellent communication, interpersonal and problem-solving skills
o Customer-centric with ability to work under pressure
o Self-motivated and independent
o Team player
Working Experience
o 2 to 3 years of working experience in medical claims processing
Education
o Diploma holder
Language
o English
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