Executive, Customer Promise - Healthcare Claims

Executive, Customer Promise - Healthcare Claims

• Adhering to our claim workflow in relation to 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
• Ensuring customers enquiry from all source of referrals are promptly attended to and resolves via appropriate communication mode.
• To ensure and monitor claims processing benchmark and turnaround time
• To correspondences on and day to day operation functions of the department and coordinates with other departments
• To handle incoming enquiries from internal or external parties via emails, phone calls and portal.
• 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 section.
• Continuously attend / involve with training for personal and career development.
• Undertake projects / other work and duties allocated by Management, as and when required
• Ensuring that Financial Services Act (FSA), Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.
• This is aPRINCIPAL DUTIES & RESPONSIBILITIES:
• Adhering to our claim workflow in relation to 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
• Ensuring customers enquiry from all source of referrals are promptly attended to and resolves via appropriate communication mode.
• To ensure and monitor claims processing benchmark and turnaround time
• To correspondences on and day to day operation functions of the department and coordinates with other departments
• To handle incoming enquiries from internal or external parties via emails, phone calls and portal.
• 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 section.
• Continuously attend / involve with training for personal and career development.
• Undertake projects / other work and duties allocated by Management, as and when required
• Ensuring that Financial Services Act (FSA), Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.
• This is a 24/7 rotation shift schedule role.

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