Executive, Customer Promise - Major Claims | Kuala Lumpur, MY

Prudential plc; Kuala Lumpur; On-site; MYR 40,000 - 70,000; Full time

Job summary

A leading company in the insurance industry is seeking a dedicated individual for claims management. This role involves ensuring efficient operational processes, assessing claims, and collaborating across departments to maintain service quality. Previous experience in claims handling is valuable, alongside relevant academic qualifications. With a commitment to diversity, Prudential offers an inclusive work environment where career ambitions are supported.

Qualifications

• Fresh graduates or 3-5 years of claims handling experience in insurance.
• Proficiency in English and Bahasa Malaysia.
• Basic insurance knowledge.

Responsibilities

• Adhere to claims workflow procedures for claims.
• Assess and approve claims according to policy terms.
• Coordinate with other departments regarding claims.

Skills

Communication skills

IT literacy

Education

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

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 on 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 Summary:

The incumbent is responsible for providing efficient and effective support to the company's goals by meeting and exceeding expectations on operational processes. Given the complexity of the insurance business, the incumbent must acquire thorough knowledge of various insurance products and operational procedures to ensure customer inquiries are resolved in accordance with service levels. The role also requires close collaboration with other departments to deliver excellent service quality to customers.

Job Scope:

The incumbent supports company objectives by ensuring operational processes are handled efficiently, with a deep understanding of insurance products and procedures to resolve customer inquiries effectively. Collaboration with other departments is essential to maintain high service standards.

Position Summary:

• Claims Examination
• Claims Recommendation
• Claims Approval within authority limits

Principal Duties & Responsibilities:

• Adhere to claims workflow procedures for major, accident, and hospitalization claims
• Assess and approve claims according to policy terms and conditions
• Approve claims within departmental benchmarks and authority limits
• Recommend claims for approval or repudiation
• Handle and respond to claims appeals promptly
• Monitor claims processing times and follow up on outstanding cases
• Coordinate with other departments regarding claims operations
• Respond to inquiries from other insurance companies via ICVS within set benchmarks
• Prepare internal and external correspondences
• Handle inquiries via email, phone, letter, or walk-ins
• Prepare reports as required by management
• Coordinate with IT for troubleshooting operational issues
• Review and update administrative rules and processes
• Participate in training and development activities
• Provide medical opinions on claims from a medical perspective
• Undertake projects and other duties as assigned

Requirements:

• Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration, or related fields
• Fresh graduates or 3-5 years of claims handling experience in the insurance or life insurance industry (especially for major claims)
• Proficiency in English and Bahasa Malaysia
• Basic insurance knowledge
• Good communication skills and IT literacy

Additional Information:

Prudential is an equal opportunity employer, committed to diversity and inclusion. We provide equal benefits and opportunities regardless of sex, race, age, ethnicity, education, social background, marital status, pregnancy, religion, disability, or employment status. Reasonable adjustments are available for individuals with specific needs.

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