Executive, Healthcare Claims

KEY RESPONSIBILITIES:

Assess claims fairly and make decisions according to policy terms and conditions.

Approve claims within the department’s benchmark, turnaround time, and authority limit.

Recommend claims for approval or repudiation, where required.

Ensure customer enquiries from all referral sources are attended to promptly and resolved through the appropriate communication channels.

Monitor claims processing benchmarks and turnaround time.

Handle daily department correspondence and coordinate with other departments when needed.

Handle enquiries from internal and external parties via email and incoming enquiries.

Support outbound calls to customers and agents for declined claims.

Liaise with Prudential Malaysia’s IT division to troubleshoot operational system issues or cases.

Review, update, and document administrative rules and processes to ensure smooth and efficient operations.

Attend training to support personal and career development.

Undertake projects, tasks, or other duties assigned by management from time to time.

QUALIFICATIONS & REQUIREMENTS:

Bachelor's Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration, or a related field.

Fresh graduates are encouraged to apply.

Candidates with 3 to 5 years of claims handling experience in the insurance industry will have an added advantage.

Good command of both English and Bahasa Malaysia.

Basic knowledge of insurance principles and practices.

Strong communication and interpersonal skills, with the ability to work independently.

Proficient in Microsoft Office applications and general IT systems.

Willing and able to work on a shift basis.

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.