Claims Assessor
9 hours ago
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.
Job Description:
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
Who we are looking for:
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
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