Executive, Customer Promise - Medical Reimbursement & Accident | Kuala Lumpur, MY

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

Job summary

A leading company in the insurance sector seeks an Executive for Customer Promise in Medical Reimbursement & Accident. The role involves supporting operational processes, handling claims, and ensuring service quality. Ideal candidates will have a relevant degree and strong communication skills, with opportunities for training and career development.

Qualifications

• Fresh graduates for the Executive role; 3-5 years of claims handling experience for Assistant Manager.
• Good command of English and Bahasa Malaysia.
• Minimal insurance knowledge for Executive; technical understanding for Assistant Manager.

Responsibilities

• Adhere to claims workflow and assess claims according to policy terms.
• Handle claims appeals and monitor claims processing.
• Record and submit statistics or reports as required.

Skills

Communication

IT Literacy

Customer Service

Education

Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration

Job description

Executive, Customer Promise - Medical Reimbursement & Accident

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 on the business, supporting their career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Job Summary:

The incumbent is responsible for providing efficient and effective support to the company's goals by meeting and exceeding expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire thorough knowledge of different insurance products (and their functionalities/technicalities) and operational processes to ensure customer inquiries are resolved according to agreed service levels. The incumbent will work closely with other operations departments to deliver excellent service quality to customers.

Principal Duties & Responsibilities:

1. Adhere to the claims workflow related to Accident and Hospitalization claims procedures.
2. Assess and approve claims according to policy terms and conditions, within departmental benchmarks, turnaround times, and authority limits.
3. Handle claims appeals, referrals, or complaints from any parties and respond within departmental benchmarks.
4. Monitor claims processing to ensure it meets departmental benchmarks and turnaround times.
5. Follow up closely on outstanding cases.
6. Handle inquiries from internal staff, branch staff, agents, policyholders/claimants, and other insurance companies, ensuring responses meet departmental benchmarks.
7. Correspond internally and externally (including agents, policyholders, employers, private investigators, FMB, and BNM) to manage daily operations and coordinate with other departments as applicable.
8. Record, update, review, prepare, and submit statistics or reports as required by management within agreed service standards.
9. Continuously review processes, identify gaps through feedback, and implement improvements; update documentation of administrative rules and processes.
10. Participate in training for personal and career development.
11. Conduct internal and external training on claims-related matters as needed.
12. Undertake projects or other duties assigned by management or related to Claims Department activities.

Requirements:

• Qualification: Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration, or related fields. Professional insurance qualifications (e.g., ACII, AMII, AAII, FLMI) are advantageous.
• Experience: Fresh graduates for the Executive role; 3-5 years of claims handling experience in the Life Insurance industry for the Assistant Manager role.
• Knowledge, Skills & Abilities: Good command of English and Bahasa Malaysia. Minimal insurance knowledge for Executive; insurance knowledge & technical understanding of Accident & Medical insurance for Assistant Manager. Ability to work independently, good communication skills, and IT literacy.

Prudential is an equal opportunity employer. We promote equality of opportunity regardless of sex, race, age, ethnicity, education, social and cultural background, marital status, pregnancy, religion, disability, or employment status. We support reasonable adjustments for individuals with physical or mental health needs.