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 on 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 for providing 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 claims requires medical knowledge and support to make decisions on claim assessments. It also involves other areas that require medical knowledge before policy commencement, which include underwriting, endorsement, and new business. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.Principal Duties & Responsibilities:Coordinate complex referrals requiring external expert opinions by consolidating information internally with external parties while adhering to compliance and regulatory rules.
Support stakeholders in dealing with difficult customers, reviewing and approving complex cases to the best of our knowledge, which may at times require second opinions.
Perform research to support and resolve complex claims cases, aiding in the development of new products, supporting management on projects, and ensuring compliance with regulatory requirements.
Provide seamless customer experience to support business growth and trust, including prompt correspondence and meetings with providers and the Ministry of Health to obtain correct provisions for claims.
Manage Doctor Panel Management by reviewing and monitoring Watchlist and Delisted Doctors, including regular audits of the Doctor Panel.
Provide advice for medical cases in Underwriting & Non-Disclosure referrals, including second opinions on ECG, Stress ECG, and other medical reports.
Assist in reviewing candidates' profiles for agent applications with medical conditions to determine suitability for becoming official Prudential Agents.
Monitor agent performance in their medical sales business through claim monitoring and medical insurance sales to ensure good medical claims experience among agents.
Handle underwriting cases that consist of sensitive medical information.
Provide claim assessment reviews for all types of medical claims to improve the quality and justification of claim assessments and meet operational expectations.
Ensure continuous learning and upgrade knowledge to assist and support daily operations in complex medical referral claim cases that require clinical or technical input.
Continuously provide excellent customer service to inter-departmental and external parties in all initiatives working together or resolving issues for the benefit of all stakeholders within the agreed service level.
Provide training and case studies to all claim assessors, underwriters, and management trainees to ensure consistent practice in claims processing and underwriting guidelines.
Improve and enhance work processes through active participation in projects, collaborating with departments to achieve greater work efficiency, improve quality, reduce error rates, and manage costs effectively.
Adhere to Local business & Group Regulatory Policies and be responsible for all duties assigned by Supervisors/HOD to meet operational and/or other requirements.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.
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