Manager, Claims Technical Excellence

Prudential Hong Kong Limited; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

An established industry player is seeking a Claims Technical Excellence Manager to lead efforts in detecting fraud and ensuring operational efficiency within the claims department. This role involves managing staff, providing training, and conducting audits to maintain high standards of compliance and quality. The ideal candidate will have a strong background in medical claims and insurance processes, along with a passion for driving improvement initiatives. Join a forward-thinking organization that values diversity and inclusion, and make a significant impact on the future of claims management.

Qualifications

• Strong knowledge in medical claims and insurance processes is essential.
• Experience in managing teams and operational processes is required.

Responsibilities

• Lead and manage staff to ensure timely completion of tasks.
• Provide training and support to claims assessors and other departments.
• Conduct claims audits and maintain compliance.

Skills

Medical Claims Fraud Detection

Insurance Processes Knowledge

Claims Management

Training and Development

Operational Efficiency

Education

Bachelor's Degree in Business or related field

Tools

Claims Management Systems

Job description

Manager, Claims Technical Excellence

Apply locations Kuala Lumpur time type Full time posted on Posted 30+ Days Ago job requisition id 24090402

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.

The incumbent is responsible for Medical Claims Fraud, Waste and Abuse (FWA) detection and Claims Avoidance Rate in Prudential to ensure long-term sustainability of the portfolio. With strong knowledge in medical and Insurance processes, the incumbent will perform training and audits, maintain system rules and guidelines to equip the Claims Department to have the capability in eliminating leakages.

Responsibilities:

1. Perform the role as a lead in managing staff and ensure tasks assigned to team members are completed within the given time to meet expectations on operational processes.
2. Assist the Senior Manager in leading and coordinating the team members to achieve the company’s goal in providing support and guidance to the Claims Department via assessor knowledge, guidelines, systems, technology, etc.
3. Support and provide analysis to internal stakeholders in monitoring effectiveness and detecting gaps to develop new initiatives and measures to achieve the goal.
4. Manage and provide claims training for claims assessors to ensure skills are continuously improved through external trainings or customized technical training programs.
5. Provide and support claims training to other departments or business partners.
6. Manage and perform claims review on claims assessors’ cases as part of the claims authority upgrade process.
7. Manage and report on claims/compliance audits to ensure quality assessment and compliance is achieved and identify any improvement areas.
8. Perform regular reviews of underwriting guidelines to ensure that they are relevant, competitive, and drive operational efficiency while maintaining good risk management and long-term sustainability of the portfolio.
9. Work closely with other departments and vendors in delivering a robust Claims process flow.
10. Develop and maintain rules in the claims system for STP and identify opportunities that provide operational efficiency, support business growth, and seamless customer experience.
11. Leverage internal & external data to understand the current state, trends, and opportunities in improvement/growth areas.
12. Support improvement in SLA and minimize penders through identifying improvement opportunities, automation, streamlining processes & guidelines.
13. Support improvement in onboarding NPS through various initiatives, manage and monitor team performance in meeting departmental service expectations and deliver excellent service quality to customers.
14. Participate in Roadshows, Quality leaders meetings, and focus group dialogues to gain insight and provide education on Medical Claims and FWA.

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.

About Us

We are Prudential. For Every Life, For Every Future.