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 of Medical Claims Fraud, Waste and Abuse (FWA) detection and Claims Avoidance Rate in Prudential to ensuring long-term sustainability of portfolio. With strong knowledge in medical and Insurance processes, the incumbent will lead a team to maintain and strengthen Claims Department's capability in eliminate leakages.
Performing the role as a lead in managing staff and to ensure task assigned to team member complete within given time to meet expectations on operational processes.
To lead and coordinating the team member to achieve the company's goal in providing support and guidance to Claims Department via assessor knowledge, guidelines, systems, technology, etc.
To support and provide analysis to internal stake holder in monitoring effectiveness and detect gaps to develop new initiatives and measures to achieve the goal.
Manage & provide claims training for claims assessors to ensure skills are continuously improved through external trainings or customized technical training program.
Provide and support claims training to other departments or business partners.
Manage and perform claims review on claims assessor cases as part of claims authority upgrade process.
Manage and report on claims/compliance audits to ensure quality assessment and compliance is achieved and identify any improvement areas.
Perform regular review of underwriting guidelines to ensure that it is relevant, competitive and to drive operational efficiency while maintaining good risk management and long-term sustainability of Portfolio.
To work closely with other departments and vendors in delivering robust Claims process flow.
Develop and maintain rules in the claims system for STP and identify opportunities that provide operational efficiency, support business growth and seamless customer experience.
Leverage on internal & external data to understand current state, trend and opportunities in improvement/growth area.
Support improvement in SLA and minimizing penders through identifying improvement opportunities, automation, streamlining processes & guidelines.
Support improvement in onboarding NPS through various initiatives, manage and monitor the team performance in meeting departmental service expectations and deliver excellent service quality to customer.
Participate in Roadshows, Quality leaders meeting and focus group dialog to gain insight and provide education on Medical Claims and FWA.
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.
