Employee Benefits Claims

Prudential Services Asia; Kuala Lumpur; On-site; MYR 60,000 - 90,000; Full time

Job summary

Prudential Services Asia is seeking an experienced Claims Adjudicator to process Group Major and Medical Claims with accuracy and urgency. You will collaborate with underwriters, CPFB, medical providers, and TPAs to ensure compliant, timely decisions.

The role requires 2–3 years of claims processing experience, strong English communication, and a customer-centric, detail-oriented mindset in a fast-paced environment.

Qualifications

• 2–3 years of life and medical claims processing experience.
• Strong focus on accuracy and quality.
• Excellent written and verbal English communication.
• Ability to work under pressure and meet service targets.
• Customer-centric approach to claims handling.

Responsibilities

• Adjudicate Group Major Claims (Death, TPD, CI, Disability, etc.) and Group Medical Claims including hospital and outpatient services.
• Ensure prudent, equitable decisions within service levels and regulatory guidelines.
• Coordinate with underwriters, CPFB, medical institutions, and TPAs as needed.
• Investigate and determine claims decisions with internal teams and external parties.
• Handle enquiries, service recovery, complaints, and appeals; provide updates on status.

Skills

Attention to detail

Communication skills

Conflict resolution

Customer-centric

Self-motivated

Team player

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 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 to the business, and 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 provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.

Job Description

Adjudicate Group Major Claims (Death, TPD, Critical Illness, Disability, Terminal Illness, etc) and Group Medical Claims (Hospital & Surgical, Major Medical, Outpatient Specialist, Outpatient Clinical, Dental, etc) and ensure delivery of prudent and equitable claims decision within expected service level (i.e. claims turnaround time). Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms. 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 relation with external parties – Central Provident Fund Board (CPFB), medical institutions, TPAs, 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. Any other ad-hoc assignment assigned.

Who we are looking for

Detail-oriented with a commitment to accuracy and quality. Innovative and resilient with a strong eye for detail Excellent communication skills in English, both written and verbal Conflict resolution and relationship management skills Customer-centric with ability to work under pressure Self-motivated and independent Team player

Working Experience

2 to 3 years of working experience in both life and medical claims processing

Education

Diploma or Degree

Language

English

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.

We are Prudential. For every life, we are partners. For every future, we are protectors. Prudential plc provides life and health insurance and asset management to 17 million customers across 20 markets in Asia and Africa. We are headquartered in Hong Kong and have dual primary listings on the Stock Exchange of Hong Kong and the London Stock Exchange. We are focused on four strategic regions: Greater China, ASEAN, India and Africa. Our customers are served by around 55,000 agents and more than 200 bank partners. Prudential plc is not affiliated in any manner with Prudential Financial, Inc., a company whose principal place of business is in the United States of America or with the Prudential Assurance Company, a subsidiary of M&G plc, a company incorporated in the United Kingdom. Find out more at www.prudentialplc.com Follow us on LinkedIn