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.Role and ResponsibilitiesIdentify global Claims best practice, define Prudential standards and ensure LBUs compliance with minimal deviationsSupport LBUs to revise and develop Claims guidelines to ensure they are appropriate to market and meet legal and regulatory requirements.Develop framework and guidelines for identifying claim cases which need to be reviewed by the Medical Support and/or Claim Investigation teamConduct claim audits / reviews at LBUs, including Third Party Administrators and make recommendations for performance improvementsGuide LBUs to improve claim automation and analytics via use of AI and technologyIdentify opportunities for the development and deployment of consistent Claims tools and capabilities across LBUs, and drive the implementationIdentify Claims specific use cases for the application of Generative AI, and work collaboratively with LBUs and Technology to get these executedUnderstand how granular data collection can enhance our claims processes, and work with relevant parties to execute these Data & Analytics use casesCollaborate with Connected Care team to understand how claims data can be used to create a more seamless, personalized patient experienceWork closely with Provider Management team to understand how to optimize the provider claims experience (cashless) making it easy and attractive for providers to partner with Prudential while at the same time building in the appropriate checks to prevent fraud, waste and abuseWork closely with Group Security to implement Claims fraud, waste and abuse solutions to timely detect abnormally leading to early investigation.Collaborate with internal stakeholders, such as Group Technology, Customer, Risk/Compliance/Security and Finance team to help deliver Prudential's Claim Promise while protecting the longer-term sustainability of our health business.Attend as a member / receive updates from LBUs Claims CommitteeSupport LBUs in assessing the required skill sets within their Claims organization, and closing potential capability gaps through training, knowledge sharing and recruitmentProvide claims input on benefits design and provision wordings at product development stageQualificationsBachelors degree in healthcare administration, health science or a related fieldExtensive experience in health claims management and analyticsIn-depth knowledge of medical insurance, healthcare billing and medical terminologyStrong analytical skills and proficiency in data analytic tools and techniquesAbility to exercise good and effective independent judgementGood interpersonal skills and able to achieve collaborative success with other functional areas
