Senior Manager, Customer Promise - Healthcare Claims

Prudential Group; Kuala Lumpur; On-site; MYR 120,000 - 150,000; Full time

Job summary

A leading insurance firm in Kuala Lumpur is seeking a Senior Manager for their Healthcare Claims team. The role involves managing operations, ensuring compliance with regulations, and leading a team to achieve operational excellence. Candidates should possess strong claims management, strategic planning, and analytical skills. The ideal applicant will have a thorough understanding of insurance products and operational processes, along with the ability to lead and motivate staff. Join a diverse and inclusive workplace where you can connect, grow, and succeed.

Benefits

Diversity and inclusion programs

Career development opportunities

Equal opportunity employer

Qualifications

• Extensive knowledge of insurance products and operational processes.
• Ability to lead and manage claims operations effectively.
• Strong analytical skills for assessing legal and industry issues.

Responsibilities

• Lead and manage the overall Claims Section Operations.
• Appraise claims and ensure compliance with company policies.
• Collaborate with stakeholders to improve claims processes.

Skills

Claims management

Strategic planning

Fraud management

Communication skills

Job description

Senior Manager, Customer Promise - Healthcare Claims

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 to manage an efficient and effective Claims team by meeting and exceeding management’s expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer’s enquiries are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.

Position Summary

• Lead and manage the overall Claims Section Operations, to drive operational excellence across all claims handling activity
• Planning of staff roster for 24/7 Operation team
• Planning overall strategy of the Unit
• Managing the day to day functions of the Unit which include people, system, procedures and others.

Principal Duties & Responsibilities

• Appraising claims up to a company-specified approval limit.
• Strategic planning, managing, coordinating, controlling and monitoring the Unit plans to ensure that the operational objectives of the department and the company are being met.
• Responsible in ensuring appropriate measures and controls on claims leakages and fraud management, monitoring of legal cases are adhered to.
• Assessing critical legal and industry issues on claims with high ambiguity and exposures to the company.
• Ensuring that Insurance Act, Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.
• Applying complicated theory and fundamentals of claims appraisals.
• Ensuring company-specific claims policy and guidelines are in line with Prudential Malaysia Claims policy and standards. This includes defining and implementing standards for accuracy, productivity and timeliness as well as recommending strategies to meet those standards.
• Reviewing and revising claims guidelines regularly to ensure that they are aligned with changes in the market, legal and regulatory environments, and product design.
• Supervising the performance of subordinates.
• Representing the department head in meetings.
• Implementing projects for the streamlining of operations or improvement of servicing capabilities.
• Determining appropriate training for subordinates to ensure that they are keeping up with market and business requirements.
• Maintain effective relationships with key stakeholders and collaborate with across business units to provide claims input into business decisions, budgeting process etc.

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.