PACS | Ops - EBO Claims - Senior Executive

Prudential Group; Kuala Lumpur; On-site; MYR 40,000 - 60,000; Full time

Job summary

A major insurance provider located in Kuala Lumpur is seeking a Senior Executive for EBO Claims who will be responsible for reviewing and approving group insurance claims. The ideal candidate will have 2 to 3 years of experience in medical claims processing and a strong command of the English language. This role involves working closely with various stakeholders and managing relationships with external parties to ensure compliance and accuracy in claims processing. An excellent opportunity for career growth within a diverse and inclusive workplace.

Qualifications

• 2 to 3 years of working experience in medical claims processing.
• Strong command of the English language (spoken and written).
• Familiarity with human anatomy, general diseases and disease management.

Responsibilities

• Review, assess and approve group insurance claims within service turnaround time.
• Adjudicate Health and medical claims ensuring accurate claims decisions.
• Manage working relations with external parties to determine claims decisions.

Skills

Strong command of the English language

Familiarity with human anatomy

Medical claims processing

Education

Diploma or Degree

Job description

PACS | Ops - EBO Claims - Senior Executive

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 review, assess and approve group insurance claims within service turnaround time. As part of this dynamic role, you will report to Team Lead, Enterprise Business Operations and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirements.

• Adjudicate Health and 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, 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.

Qualifications & Requirements

• Strong command of the English language (spoken and written).
• Familiarity with human anatomy, general diseases and disease management.
• 2 to 3 years of working experience in medical claims processing.
• Diploma or Degree.
• English language proficiency.

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.