Assistant Manager, Customer Promise - Medical Reimbursement & Accident

Assistant Manager, Customer Promise - Medical Reimbursement & Accident

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.

Job Summary

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.

Position Summary

• Claims Examination
• Claims Recommendation
• Claims Approval within authority limit

• Adhering to our claims workflow in relation to major, accident and hospitalization claims procedure.
• 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.
• Ensure claims appeal from any parties are attended and responded to within the benchmark set by the department.
• Monitor claims processing benchmark and turnaround time.
• Follow up on outstanding cases.
• Correspond on day-to-day operation functions of the department and coordinate with other departments.
• Handle queries from other insurance companies via ICVS and ensure responses are within the benchmark set by ISM.
• Prepare correspondences both internally (sales advisor and other departments) and externally (policyholders, employer, private investigator, FMB/BNM and repudiation letter).
• Handle incoming enquiries from internal or external parties via emails, phone calls, letters, and walk-in customers.
• Update and submit reports as required by management within the agreed service standards.
• Liaise with Prudential Malaysia’s IT division to troubleshoot issues / cases encountered in day-to-day operations.
• Continuously review and update/document the administrative rules and processes for effective and efficient operation of the sections.
• Attend and involve in training for personal and career development.
• Review and provide opinion from a medical perspective (e.g., medical conditions, treatments, conformity to contract definition, etc.).
• Undertake projects and other work and duties allocated by management as required.

REQUIREMENTS:

• Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, or Business Administration.
• 3 to 5 years of experience in Major Claims from the Life Insurance industry.
• Good communication skills.
• Must be IT literate.

Prudential is an equal opportunity employer. We provide equality of opportunity and benefits for all who apply and perform work for our organization 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.