Assistant Manager, Claims (Major)
At Prudential, we understand that success comes from the talent and commitment of our people. Together, we have a shared vision in securing the future of our customers and our communities. We strive to build a business that you can shape, an inclusive workplace where everyone's ideas are valued and a culture where we can thrive together. Our people stay connected and tuned in to what's happening around us, keeping us ahead of the curve. While focused on the long-term, we look to the future to bring growth, development and benefit to everyone whose lives we touch.
The incumbent is responsible to provide efficient and effective support to the Company goals by meeting and exceeding their 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.
- Claims Examination
- Claims Recommendation
- Claims Approval within authority limit PRINCIPAL DUTIES & RESPONSIBILITIES:
- Adhering to our claims workflow in relation to major, accident and hospitalization claims procedure. (ie CI, TPD and Deat claims)
- Assess and provide justifiable claims according to policy terms and conditions to our valued policy holders.
- Approving claims within the department benchmark/turnaround time and authority limit.
- Recommend for claim approval/repudiation.
- To ensure claims appeal from any parties are attended and respond within the benchmark set by the department.
- To ensure and monitor claims processing benchmark and turnaround time.
- To closely follow up on out-standing cases.
- To correspondences on and day to day operation functions of the department and coordinates with other departments.
- To handle queries from other insurance companies via ICVS and ensure the respond within the benchmark set by ISM.
- To prepare correspondences both internally (sales advisor and other departments) and externally (policyholders, employer, private investigator, FMB/BNM and repudiation letter.
- To handle incoming enquiries from internal or external parties via emails, phone calls, letter and walk in customers.
- Updating and submission of reports as required by management within the agreed service standards.
- Liaise with Prudential Malaysia's IT division to troubleshoot issues / cases encountered in the day to day operations.
- Continuously review and update/document the administrative rules and processes for effective and efficient operation of the sections.
- Continuously attend / involve with training for personal and career development.
- To review and provide opinion from medical perspective eg medical conditions, treatments, conformity to contract definition etc.
- Undertake projects / other work and duties allocated by management as and when required.
- Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration and etc
- With 3 to 5 years in Major Claims from Life Insurance industry. (a Must on Major Claims)
- Good communication skills, Good command in English and Bahasa Malaysia
- Must be IT literate