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Senior Claims Assessor
2 weeks ago
Job Description Summary
In this role in the PRUShield Claims team (PSC), you will assist the Team Lead of the Inpatient Team to oversee the daily BAU operations, including Pre-authorisation,and High-Net-Worth claims. You will be required to review complex claim and appeal.
You must adhere to the SLA and KPI. You have to ensure the delivery of claims services are aligning with our Claims Promise. You are expected to support BAU claim processing and work. In the course of your work, you will need to liaise with internal stakeholders from other departments, example the Technical team, POS and Underwriting team specifically. At times, you will also be required to liaise with the Financial Consultants, medical institutions, doctors and CPF Board.
You must ensure that within the course of your work, you are at all times compliant with internal policy and regulatory requirements well as our SOP.
This role requires you to be accountable and responsible for the following:
- Timely BAU processing within the SLA
- Manage the processing of High-Net-Worth claims and to oversee Pre-authorisation
- Oversee and take the necessary steps to manage suspicious claims and investigation, including claims costs management.
- Manage communications, queries, feedback, and complaints on PRUShield claims from internal and external customers. This includes the review of appeals and ex-gratia considerations.
- Work closely with the internal stakeholders, including managing the complaints raised by customers and/or our Financial Consultants. This includes any disputes that are escalated to external dispute resolution channels, litigations eg. FIDReC, MOH etc.
Who we are looking for:
- Excellent communication, interpersonal and problem-solving skills
- Has the ability to think out of the box, evaluate and reach an appropriate decision
- Customer-centric and empathetic
- Able to work under intense pressure and tight timeline
- Accountable, self-motivated, and able to work independently
- Good product knowledge and able to comprehend proficiently the intent and spirit of the policy coverage while aligning to the terms and conditions of the policy provisions
- Excellent skills and competencies in claims adjudication
- Innovative
- Team player and has excellent leadership skill
- Ability to build and maintain trusted relationship with internal and external customers, especially with our distribution force
- Ability to guide and support the team through business changes, and maintain positive morale with the team
Working Experience
- With past para-medical experience will be an added advantage
- At least 6 years of experience in medical claims operations
Professional Qualifications
- HI, LOMA certified or its equivalent
Education
- Degree in any discipline
Language
- Strong command of English (oral and written)
