M - Claim Management & Reporting
3 days ago
Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow and Succeed.
Principle Duties & Responsibilities:
Liaise with PLA team relate to claim process (both cashless & reimburse claim), who are responsible to deliver:
- Coordinating PLA claim teams
- Checking completeness and validity documents according to the SOP.
- Analyze and approved discharge and case monitoring case based on authority limit
- Monitoring performance and improve service standard and turnaround time within agreed SLA.
- Give the guidance and solution for problem case received in claim team
- Improvement of product & system knowledge of team members
- To ensure that no backlog in PLA’s claim process by monitoring dashboard
- Responsible to prepare all claims reporting for management needs
Do personal Claim Assessment
- Perform complete claim assessment up to his / her authority limit
- Centre of excellence for escalation point to solve any inquiries from frontlines and Management related PSLA claim cases (both cashless & Reimburse claim)
- Handling complaint and error monitoring from front liners and management (both cashless & Reimburse claim)
- Reviewing PSLA claim cases from PLA’s team (both cashless & Reimburse claim)
- Reviewing and proposing PSLA ex-gratia cases to get re-Insurance and Management approval
- Help claim analyst to review complex cases
- Receive inquiries from Hospitals
- Handling complaints from Hospitals
- Coordinate with re-insurance and management for complex cases
Being a team leader who holds RESPECT:
- Lead team members with RESPECT
- Ensure team member attends/passes trainings/exams required
- Contribute constructive ideas and knowledge for overall team member development.
- Monitor service standard team by having productivity, errors and turnaround time report
- Create honest, supportive, open and competitive environment in team by having sufficient communications with team members
- Maintain individual punctuality of team members
- Maintain shifting schedule of team members
- Monitor and adjust team member distribution case
- Maintain procedure in leave days is proper
Ensure smooth communication with other departments within PSLA and PLA
- Doing meeting with other departments as needed to solve Claims issues
- Coordinate with related parties (investigator, CTPAS, QA, ReUW, PHS, TPA relation, provider relation)
- Ensure customer orientation is the basis for every approach
Liaise with Legal & Compliance to report suspicious transactions that finding in doing daily process
Personal development:
- Attend/pass minimum 1 courses/ exams from LOMA modules or courses in risk management
- Proactively in project and contribute initiative to enhance system and flow process to have effective and efficient process
- Do ad hoc task/project (if been assigned)
Job Specification:
Qualification
Minimum S1 (bachelor Degree)_Medical doctor is preferable
Experience
It would be preferred if any experience in Life Insurance Company / insurance third party administration.
Knowledge
Apart form the existing experience, knowledge-claim process, policy provisions and other factors that determine the best around, although not have understood had the goods on the need to increase sustainable.
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