Assistant Manager, Customer Promise - Major Claims
Prudential
- Kuala Lumpur
- Permanent
- Full-time
- Claims Examination
- Claims Recommendation
- Claims Approval within authority limitPRINCIPAL DUTIES & RESPONSIBILITIES:
- Adhering to our claims workflow in relation to major, accident and 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.
- To ensure claims appeal from any parties are attended and respond within the benchmark set by the department.
- To ensure and monitor claims processing benchmark and turnaround time.
- To closely follow up on out-standing cases.
- To correspondences on and day to day operation functions of the department and coordinates with other departments.
- To handle queries from other insurance companies via ICVS and ensure the respond within the benchmark set by ISM.
- To prepare correspondences both internally (sales advisor and other departments) and externally (policyholders, employer, private investigator, FMB/BNM and repudiation letter.
- To handle incoming enquiries from internal or external parties via emails, phone calls, letter and walk in customers.
- 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 sections.
- Continuously attend / involve with training for personal and career development.
- To review and provide opinion from medical perspective eg medical conditions, treatments, conformity to contract definition etc.
- Undertake projects / other work and duties allocated by management as and when required.
- Degree in Biomedical Science, Biology, Mathematics, Economics, Statistics, Business Administration.
- With 3 to 5 years in Major Claims from Life Insurance industry.
- Good communication skills
- Must be IT literate