Claims Administrator

Prudential Group; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

A global insurance provider seeks an experienced claims processor in Kuala Lumpur. The role focuses on adjudicating health and medical claims, ensuring compliance with regulations while improving claims processes. Candidates should have 2-3 years of medical claims processing experience and a diploma or degree. Strong English skills are essential. This position offers opportunities for growth in a diverse and inclusive environment.

Qualifications

• 2 to 3 years of working experience in medical claims processing.
• Strong spoken and written English proficiency.

Responsibilities

• Adjudicate health and medical claims, ensuring timely decisions.
• Comply with regulatory requirements and company policies.
• Review workflow for process improvements.

Skills

Strong command of the English language

Familiarity with human anatomy

Knowledge of general diseases

Education

Diploma or Degree

Job description

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do with a culture that celebrates diversity and inclusion. This role supports a dynamic ecosystem that values innovation, agility, and teamwork.

Responsibilities

• Adjudicate Health and medical claims and ensure delivery of prudent and equitable claims decisions within the expected service level (i.e. claims turnaround time).
• Comply with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
• Review workflow and claims processes to identify areas of improvement and implement enhancements to achieve efficient claims administration.
• 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 relationship 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.

Qualifications

Working Experience

• 2 to 3 years of working experience in medical claims processing

Education

• Diploma or Degree

Language

• English

Competencies & Personal Traits

• Strong command of the English language (spoken and written)
• Familiarity with human anatomy, general diseases and disease management

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part‑time / fixed‑term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third‑party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.