Executive, Claims

Prudential Hong Kong Limited; Kuala Lumpur; On-site; MYR 36,000 - 60,000; Full time

Job summary

A leading company in the insurance sector is looking for a dedicated claims professional to manage and adjudicate medical claims. The ideal candidate will have strong communication skills and 2-3 years of experience in medical claims processing, ensuring compliance and efficient service delivery. Join Prudential and contribute to a culture of diversity and inclusion while supporting career ambitions.

Qualifications

• 2 to 3 years of working experience in medical claims processing.
• Strong command of the English language (spoken and written).
• Ability to work under pressure.

Responsibilities

• Adjudicate group outpatient medical claims.
• Ensure compliance with regulatory requirements and corporate guidelines.
• Manage investigations of claims with various stakeholders.

Skills

Conflict resolution

Relationship management

Problem-solving

Communication

Customer-centric

Team player

Education

Diploma holder

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.

Job Profile Summary :

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 outpatient medical claims 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.
• Review workflow and claims processes to identify areas of improvement and implement enhancement 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 relation with external parties – Central Provident Fund Board (CPFB), regulator, financial consultants, bancassurance partners, 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:

• Strong command of the English language (spoken and written)
• Conflict resolution and relationship management skills
• Excellent communication, interpersonal and problem-solving 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 medical claims processing

Education

• Diploma holder

Language

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, For Every Future.

Prudential plc provides life and health insurance and asset management to 18 million customers across 24 markets in Asia and Africa.

We are headquartered in London and Hong Kong and are focused on four strategic regions: Greater China, ASEAN, India and Africa. We are served by around 68,000 average monthly active 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.