Claims Consultant

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 the review of complex claim and appeal. You will assist the Team Lead to ensure the Performance Indicator, SLA and quality customer experience delivery are aligning with our Claims Promise. You will also need to support BAU claim processing and work with the relevant technical team for process improvement and enhancement. You are also expected to support technical claims training and product discussion when necessary.

As part of this dynamic role, you will report to the Team Lead of the Inpatient Team, under the Medical Portfolio Management Department. You will work closely with various internal stakeholders to manage PRUShield Claims that require special or delicate handling, being compliant with internal policy and regulatory requirement and meet monthly service objectives (SLA) and supporting the Team Lead in audit and compliance related matters.
- Timely BAU processing within the SLA
- Take charge of the Pre-authorisation team
- Support the periodic technical claims training for the Inpatient team to 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.
- Support and deputise the Team Lead to oversee the day-to-day operations of the PRUShield Claims team (PSC) 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.
- Manage communications, queries, feedback, and complaints on PRUShield claims from internal and external customers. This includes the review of appeals and ex-gratia considerations.
- Support agency engagements and build good rapport with our distribution force.
- Work closely with the Customer Management Unit (CMU) to resolving issues and 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.
- Support the Team Lead to formulate strategic planning, claims policies and procedures to achieve a balance in prompt claims settlement and accurate claims adjudication.
- Work closely with the Lead of Process Improvement to achieve operational efficiency and effectiveness. This involves working closely with the BA, Technology, IT, OPEX Center of Excellence team and other digital platform owners to achieve the best possible outcome of business efficiency.
- Work together with the Team Leads of the Pre/Post team and Servicing team to achieve synergy effect while maintaining a strong, cohesive, relevant, and efficient ONE team spirit

Additional Job Description

**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
- 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:
At least 6 years of relevant experience

**Education**:

- At least a degree holder in any discipline

**Language**:
Strong command of English, oral and written