Manager, Medical Support
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.
Job Summary
The incumbent is responsible to provide efficient and effective medical support to the Company goals by meeting and exceeding their expectations on operational processes.
The complexity of the insurance business in medical claim required medical knowledge and support to make decision of claim assessment. It also involves other area that require medical knowledge before policy commenced which include underwriter, endorsement and new business. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.
Principal Duties & Responsibilities:
To coordinate the complex referral requiring external expert's opinion by consolidating information internally with the external party without disregards the compliance and regulatory rules set.
To support any stake holders in dealing with difficult customers, reviewing and approving on complex cases to the best knowledge we can which at time may require second opinion and etc.
Perform research to support and resolve complex claims cases, supporting development of new products, supporting management on any project and broadcast interviews or regulatory requirement to ensure our due diligent met and ensure we are upholding our business integrity in paying fair claims.
To support the business by providing seamless customer experience for continuity of business growth and trust in building protection through prompt correspondence include meeting up with the provider as when require, and with ministry of health to obtain correct provision under which claim can be paid to be paid for consistency.
To manage Doctor Panel Management in providing review and monitoring of Watchlist and Delisted Drs. This will include regular audit of Doctor Panel.
Provide advice for medical cases in Underwriting & Non-Disclosure referrals which include second opinion on ECG, Stress ECG, other medical reports
To assist in reviewing candidates profile for agent application that have medical condition whether it fit to become official Prudential Agent.
To monitor performance of agent in their medical sales business thru claim monitoring and medical insurance sales. This to ensure good medical claims experience amongst agents.
Handling underwriting cases that consist of sensitive medical information.
To provide claim assessment review which include all type of medical claim to improve quality justification of claim assessment and meet expectations on operational processes.
To ensure continuous learning and upgrade knowledge in order to assist and support the daily operation in complex medical referral claim cases which require clinical input or even technical input.
Continuously provide excellent customer service to inter-departmental and external party in all initiative working together or resolving issues for the benefits of all our stake holders within the agreed service level.
To provide training, case study to all claim assessors, underwriter and management trainee in ensuring consistent practice in claims processing & underwriting guidelines.
To improve and enhance through active participation of projects on existing work process, system by rendering full collaboration to the department or to achieve stake holders to achieve more work efficiency; improve work quality, reduce error rate for cost saving in managing the claims and reduction in management of expense.
At all times adhere to Local business & Group Regulatory Policies. Agreed & responsible on all duties assigned by the Supervisors/HOD in order to meet operational and/or other requirements
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 24080478
