Senior Executive, Claims

Prudential Services Asia; Kuala Lumpur; On-site; MYR 67,000 - 100,000; Full time

Job summary

Prudential is seeking a Life & Health Claims Assessor in Malaysia to adjudicate A&H claims, ensuring prudent and timely decisions. The role requires strong English communication, collaboration with medical and financial partners, and adherence to regulatory standards.

Candidates typically have 1–2 years of Life & Health claims experience, with basic Chinese being a plus. The ideal person works well under pressure, maintains customer focus, and can work independently within a team.

Qualifications

• Excellent communication, interpersonal and problem-solving skills.
• Strong customer-centric approach with ability to work under pressure.
• Self-motivated and able to work independently.
• Team player with maturity and leadership quality.
• Good medical knowledge and claims settlement procedure.
• Ability to read basic Chinese will be advantageous.

Responsibilities

• Adjudicate Accident & Health (A&H) claims and ensure prudent, timely decisions.
• Comply with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
• Manage claims investigations with claimants, financial consultants, medical institutions, insurers, etc.
• Follow up on outstanding requirements for adjudication and provide regular status updates.
• Work closely with other units to ensure accurate processing and SLAs.
• Handle enquiries and appeals arising from claims.

Skills

Communication

Problem solving

Customer focus

Independent

Team player

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.

ROLE PURPOSE

Provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.

ROLE DUTIES & RESPONSIBILITIES

This role is accountable and responsible for the following:

• Adjudicate Accident & Health (A&H) claims and ensure delivery of prudent and equitable claims decision within expected service level.
• Compliant with regulatory requirements, corporate guidelines, policy wording and reinsurance terms.
• Manage claims investigation by working with claimants, financial consultants, medical institutions, insurers, etc to determine claims decision and payment.
• Follow up on outstanding requirements needed for claims adjudication through documented follow-up process and provide regular update on claims status.
• Work closely with other business units to ensure that claims are processed accurately and that all service level agreements are met.
• Manage enquiries and appeals arising from claims.

KEY PERFORMANCE INDICATORS

• Improving the customer's Instant experiences on claims by: Ensuring that the claims are processed within the expected service level;
• Attaining the benchmarked targets for productivity, claims pending rate, suspense management rate

Additional Job Description Competencies & Personal Traits

• Excellent communication, interpersonal and problem-solving skills with ability to investigate, evaluate and reach an appropriate decision
• Customer-centric with ability to work under pressure
• Self-motivated and able to work independently
• Team player, mature, with excellent leadership quality.
• Good medical knowledge and claims settlement procedure.
• Ability to read basic Chinese will be advantageous

Working Experience

At least 1-2 years of experience as a Life & Health claims assessor

Language

• Strong command of English language
• Basic Chinese will be advantageous

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, we are partners. For every future, we are protectors. Prudential plc provides life and health insurance and asset management to 17 million customers across 20 markets in Asia and Africa. We are headquartered in Hong Kong and have dual primary listings on the Stock Exchange of Hong Kong and the London Stock Exchange. We are focused on four strategic regions: Greater China, ASEAN, India and Africa. Our customers are served by around 55,000 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.

Find out more at www.prudentialplc.com

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