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 Responsibilities
- Identify global Claims best practice, define Prudential standards and ensure LBUs compliance with minimal deviations
- Support 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 team
- Conduct claim audits / reviews at LBUs, including Third Party Administrators and make recommendations for performance improvements
- Guide LBUs to improve claim automation and analytics via use of AI and technology
- Identify opportunities for the development and deployment of consistent Claims tools and capabilities across LBUs, and drive the implementation
- Identify Claims specific use cases for the application of Generative AI, and work collaboratively with LBUs and Technology to get these executed
- Understand how granular data collection can enhance our claims processes, and work with relevant parties to execute these Data & Analytics use cases
- Collaborate with Connected Care team to understand how claims data can be used to create a more seamless, personalized patient experience
- Work 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 abuse
- Work 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 Committee
- Support LBUs in assessing the required skill sets within their Claims organization, and closing potential capability gaps through training, knowledge sharing and recruitment
- Provide claims input on benefits design and provision wordings at product development stage
Qualifications
- Bachelors degree in healthcare administration, health science or a related field
- Extensive experience in health claims management and analytics
- In-depth knowledge of medical insurance, healthcare billing and medical terminology
- Strong analytical skills and proficiency in data analytic tools and techniques
- Ability to exercise good and effective independent judgement
- Good interpersonal skills and able to achieve collaborative success with other functional areas
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.
