Claims Consultant

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.

In this role, you will oversee the daily operations of the PRUShield Claims Inpatient team (including the Pre-authorisation team) to achieve the expected Key Performance Indicator, SLA and quality customer experience delivery. You will be working together with the Head of PRUShield Claims to in supporting the business and process improvement and/or system enhancement projects to improve operational efficiency and customer centricity.

You are also required to provide dedicated PRUShield claims services to policyholders and Financial Consultants in ensuring delivery of key service objectives through efficient and effective claims management.

As part of this dynamic role, you will report to the Head of PRUShield Claims (under the Medical Portfolio Management Department). You will work closely with various internal stakeholders to manage PRUShield Claims that require special or delicate handling, compliant with internal policy and regulatory requirement and meet monthly service objectives (SLA).

This role is accountable and responsible for the following:

- Deputise and assist the Head of PRUShield Claims to oversee the day-to-day operations of the PRUShield Claims team to ensure that the expected KPI, turnaround and quality of service delivery are met.
- Oversee and take the necessary steps to manage suspicious claims and investigation
- Ensure the Inpatient team has adequate on-the-job training to administer proper disbursement of claims settlement as well as proper rejection of non-admissible claims.
- Manage communications, queries, feedback and complaints on claims from internal and external customers. This would include review of appeals and ex-gratia.
- To work closely with the Customer Management Unit to resolve issues raised by customers, including disputes that are escalated to FIDREC and litigations (if any).
- Support and work with the Head of PRUShield Claims to formulate strategic planning, claims policies and procedures to achieve a balance in prompt claims settlement and accurate claims adjudication.
- The Process Improvement Lead will report into your charge. You are expected to work closely with the Lead to improve work processes to achieve operational efficiency and effectiveness. This involves working closely with the BA, Technology and OPEX team to achieve the best possible outcome of business efficiency.
- Manage vendors and outsourced parties.
- Work together with the Team Leads of the respective sections within PRUShield Claims to build and maintain a strong, cohesive, relevant and efficient one team, which comprises of the Pre-Post claims, and PRUShield Claims Servicing teams.

Who we are looking for:
Competencies & Personal Traits
- 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
- Self-motivated and able to work independently
- Good product knowledge
- Excellent skills and competencies in claims adjudication
- Innovative
- Team player
- Ability to build and maintain trusted relationship with internal and external customers
- Ability to guide and support the team through business changes, and maintain positive morale with the team

Working Experience

At least 10 years of relevant experience

Professional Qualifications
- LOMA certified, HI and/or equivalent

Education
- Degree holder

Language
- Strong command of English, oral and written