PAMB | Manager 2, Medical Support
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 medical support to the Company goals by meeting and exceeding their expectations on operational processes.
The complexity of the insurance business in medical claim required medical knowledge and support to make decision of claim assessment. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers. Principal Duties & Responsibilities:
Job Specification: Qualifications
- To coordinate the complex referral requiring external expert's opinion by consolidating information internally with the external party without disregards the compliance and regulatory rules set.
- To support any stake holders in dealing with difficult customers, reviewing and approving on complex cases to the best knowledge we can which at time may require second opinion and etc.
- Perform research to support and resolve complex claims cases, supporting development of new products, supporting management on any project and broadcast interviews or regulatory requirement to ensure our due diligent met and ensure we are upholding our business integrity in paying fair claims.
- To support the business by providing seamless customer experience for continuity of business growth and trust in building protection through prompt correspondence include meeting up with the provider as when require, and with ministry of health to obtain correct provision under which claim can be paid to be paid for consistency.-
- To provide claim assessment review which include all type of medical claim to improve quality justification of claim assessment and meet expectations on operational processes.
- To ensure continuous learning and upgrade knowledge in order to assist and support the daily operation in complex medical referral cases which require clinical input or even technical input.
- To ensure task assigned include claims under review, medical referral with complexity from aspect of diagnosis, treatment and technology used is being resolved within the service level agreed.
- Continuously provide excellent customer service to inter-departmental and external party in all initiative working together or resolving issues for the benefits of all our stake holders within the agreed service level.
- To provide training, case study to all assessors and management trainee in ensuring consistent practice in claims processing align with products sold and its products term & condition.
- To improve and enhance through active participation of projects on existing work process, system by rendering full collaboration to the department or to achieve stake holders to achieve more work efficiency; improve work quality, reduce error rate for cost saving in managing the claims and reduction in management of expense.
- To ensure support to operation team through daily operation processing, quality audit, maintained & updating the procedural to meet the benchmarks set for the medical claims assessment.
- At all times adhere to Local business & Group Regulatory Policies. Agreed & responsible on all duties assigned by the Supervisors/HOD in order to meet operational and/or other requirements
- Degree in Medical Degree and/or Nursing Degree/Diploma.
- Other Allied Health or Health Care qualification ie: Business Administrative and Management with additional skills in Insurance, analytic will be advantage.
- Preferably having experience in providing healthcare services such as clinical evaluation, handling of patient and liaison with healthcare providers, had administrative work & resolving customer service enquiry is advantage.
- Incumbent is requiring having at least 3 year's experiences in insurance industry & exposure analysis & training of staffs in medical claims assessment.
- Experience in healthcare as front office or any financial institutions, i.e. Banks, Insurance will be an added advantage.
- Customer service-related Life Claims or Medical Insurance.