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Job Description

Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow and Succeed. Principle Duties & Responsibilities: Liaise with PLA team relate to claim process (both cashless & reimburse claim), who are responsible to deliver:
  • Coordinating PLA claim teams
  • Checking completeness and validity documents according to the SOP.
  • Analyze and approved discharge and case monitoring case based on authority limit
  • Monitoring performance and improve service standard and turnaround time within agreed SLA.
  • Give the guidance and solution for problem case received in claim team
  • Improvement of product & system knowledge of team members
  • To ensure that no backlog in PLA’s claim process by monitoring dashboard
  • Responsible to prepare all claims reporting for management needs

Do personal Claim Assessment
  • Perform complete claim assessment up to his / her authority limit
  • Centre of excellence for escalation point to solve any inquiries from frontlines and Management related PSLA claim cases (both cashless & Reimburse claim)
  • Handling complaint and error monitoring from front liners and management (both cashless & Reimburse claim)
  • Reviewing PSLA claim cases from PLA’s team (both cashless & Reimburse claim)
  • Reviewing and proposing PSLA ex-gratia cases to get re-Insurance and Management approval
  • Help claim analyst to review complex cases
  • Receive inquiries from Hospitals
  • Handling complaints from Hospitals
  • Coordinate with re-insurance and management for complex cases
Being a team leader who holds RESPECT:
  • Lead team members with RESPECT
  • Ensure team member attends/passes trainings/exams required
  • Contribute constructive ideas and knowledge for overall team member development.
  • Monitor service standard team by having productivity, errors and turnaround time report
  • Create honest, supportive, open and competitive environment in team by having sufficient communications with team members
  • Maintain individual punctuality of team members
  • Maintain shifting schedule of team members
  • Monitor and adjust team member distribution case
  • Maintain procedure in leave days is proper
Ensure smooth communication with other departments within PSLA and PLA
  • Doing meeting with other departments as needed to solve Claims issues
  • Coordinate with related parties (investigator, CTPAS, QA, ReUW, PHS, TPA relation, provider relation)
  • Ensure customer orientation is the basis for every approach
Liaise with Legal & Compliance to report suspicious transactions that finding in doing daily process Personal development:
  • Attend/pass minimum 1 courses/ exams from LOMA modules or courses in risk management
  • Proactively in project and contribute initiative to enhance system and flow process to have effective and efficient process
  • Do ad hoc task/project (if been assigned)
Job Specification: Qualification Minimum S1 (bachelor Degree)_Medical doctor is preferable Experience It would be preferred if any experience in Life Insurance Company / insurance third party administration. Knowledge Apart form the existing experience, knowledge-claim process, policy provisions and other factors that determine the best around, although not have understood had the goods on the need to increase sustainable.
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 special requirements.

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Job Detail

  • Job Id
    50ddef866cee0556
  • Location
    id
  • Company
  • Type
    Private
  • Employment Status
    Permanent
  • Positions
    Available
  • Career Level
    Experience
  • Gender
    Male/Female

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