Group & Medical Benefits Claims Specialist

Prudential; 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 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.