Claims Operations Leader: Strategy & Service

Prudential BSN Takaful Berhad; Kuala Lumpur; On-site; MYR 90,000 - 130,000; Full time

Job summary

Prudential is seeking a senior operational leader to oversee medical and life insurance claims for individual policies and group benefits in Kuala Lumpur. You will direct the claims operations team, optimize workflows, and drive continuous improvement across accuracy, speed, and customer satisfaction.

The role requires extensive leadership experience in medical insurance operations, strong strategic and analytical capabilities, and robust stakeholder engagement with underwriters, brokers, and

Qualifications

• Bachelor's degree in Business Administration, Insurance/Takaful, or a related field is required.
• At least 8–10 years in operation management, with 5–10 years in leadership roles.
• In-depth knowledge of medical and life insurance claims operations.
• Strong leadership and team management skills are essential.
• Excellent analytical and problem-solving abilities are required.
• Exceptional communication and interpersonal skills are necessary.
• Proficiency in claims management software and data analytics tools is a must.
• Experience in strategic planning and execution is required.
• Commitment to customer service excellence is essential.
• Financial acumen is necessary for this role.

Responsibilities

• Oversee processing of medical and life insurance claims for individual policies and employee group benefits.
• Ensure productivity and timely, accurate processing of pay and file claims and cashless admissions.
• Develop and implement claims management strategies to improve efficiency and customer satisfaction.
• Develop and maintain staff rosters ensuring optimal coverage and compliance with labor laws.
• Conduct fraud investigations timely and accordingly.
• Lead and manage the claims operations team, including processors and investigators.
• Provide training, mentorship, and performance evaluations to team members.
• Foster a collaborative and high-performance work environment.
• Streamline claims processing workflows to enhance productivity and reduce turnaround times.
• Implement best practices and continuous improvement initiatives in claims operations.
• Monitor KPIs and ensure regulatory compliance.
• Ensure a customer-centric approach in all claims handling processes.
• Address escalated claims issues and customer complaints.
• Collaborate with customer service teams to enhance the overall customer experience.
• Collaborate with underwriters, brokers, and healthcare providers.
• Maintain strong partnerships to facilitate smooth claims processing.
• Represent the claims department in meetings and industry forums.
• Prepare and present regular reports on claims performance and trends.
• Utilize data analytics to drive decision-making and strategic planning.
• Ensure accurate and timely reporting to senior management.
• Manage the claims budget and ensure cost-effective operations.
• Project management to ensure smooth system migration for product rollout, timely UAT, and operations enhancement

Skills

Leadership

Strategic planning

Data analytics

Regulatory knowledge

Communication

Project management

Stakeholder management

Financial acumen

Claims software

Customer service

Education

Bachelor's degree (Business Administration/Insurance)

Tools

Claims management software

Data analytics tools

Job description

Prudential is seeking a senior operational leader to oversee medical and life insurance claims for individual policies and group benefits in Kuala Lumpur. You will direct the claims operations team, optimize workflows, and drive continuous improvement across accuracy, speed, and customer satisfaction.

The role requires extensive leadership experience in medical insurance operations, strong strategic and analytical capabilities, and robust stakeholder engagement with underwriters, brokers, and