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PBTB | Executive, Claims

Prudential plc Kuala Lumpur, Malaysia
Posted 18 days ago Permanent Competitive
PBTB | Executive, Claims
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.

The incumbent is responsible to process HAS cases efficiently by meeting and exceeding management's expectations, technically and operationally.

Roles & Responsibilities
  • Ensure all Pre-Authorization Letter (PAL) request faxed or emailed by hospitals to be indexed and registered into claims system accordingly.
  • Validate the information stated in the Pre-Authorization Form completed by the client and attending doctor, assess the request, calculate the correct amount coverable and make a correct decision accordance to benefit terms & Claims SOP.
  • Ascertain the accurate data entry such as ICD10 Diagnosis Code, Surgery and Consultation Code (per PHA Schedule) and items charged per bills issued by hospital.
  • Liaise with hospital personnel including nurses and doctors via phone-call / emails/ writing letters appropriately to obtain necessary information in processing PAL request.
  • Process Pre & Final -Authorization Letter request within the agreed Service Level accordance to daily productivity target.
  • Participate in product and technical trainings as well as work with supervisor for additional training plans in acquiring and improving industry or technical knowledge.
  • Ensures compliance with all regulatory (internal and external) and corporate requirements.
  • Manage customer/ agent/ hospital enquiries and provide feedback/response appropriately.

Job Requirements:
  • A degree in Biomedical Science, Insurance and Risk Management or any field related to Insurance or Takaful, preferably with Life Science background.
  • Possess in-depth knowledge of basic life products (inclusive of its functionalities/technicalities) and operational processes for at least 3 years will be an advantage.
  • Customer focused with excellent problem-solving skills, the ability to work with a positive attitude & excel under pressure.
  • Self-motivated, love challenges and working with people.
  • Proficient in English both oral and in writing.
  • Proficient in Microsoft Office/Lotus Smart Suites applications.

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation 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.
Job ID  24050218
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