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.
Responsible for overseeing the Group Admin and Medical (GAM) team. Evaluate and process insurance claims, including inpatient and outpatient claims, ensuring accuracy and efficiency. This role involves managing a team of data input and/or assessors, reviewing complex claims, and implementing strategies to improve claims processes. The Manager also supports the onshore Policy Admin/Claims Manager/Senior Manager/Claims Head in achieving departmental goals. Provide enquiry support and actively participate in claim projects aimed at enhancing operational efficiency. Supervise subordinates in addressing daily operational issues. Ensure timely responses to stakeholders and/or complaints from regulators or clients. Provide support for claims audit.
Team Management:
- Supervise and mentor a team of claims assessors.
- Allocate resources effectively for daily tasks.
- Provide guidance and support to team members.
- Manage offshore team’s staff performance.
- Ensure all claims decisions are made within turnaround times with high accuracy.
Claims Evaluation:
- Oversee the assessment of complex claim submissions to ensure completeness and accuracy.
Verification:
- Ensure thorough verification of claims by cross-checking information with relevant sources.
Communication:
- Facilitate effective communication with claimants, medical professionals, and other stakeholders to gather necessary information.
Documentation:
- Maintain comprehensive records of claims assessments and decisions.
- Develop and maintain updated user manuals and guidelines.
Reporting:
- Prepare various reports including daily performance reports, staff performance reports, case status reports, training reports, and incident reports.
- Analyze claim trends to support the onshore Claims Manager.
Compliance:
- Ensure all requests are processed in compliance with company policies and regulatory requirements.
Customer Service:
- Provide exceptional customer service to claimants and stakeholders, addressing their inquiries and concerns promptly.
Process Improvement:
- Develop and implement strategies to improve claims assessment processes.
Audit and Support:
- Assist and support the Onshore Claims Manager in achieving audit purposes and departmental goals and objectives.
Ad Hoc Assignments:
- Handle ad hoc assignments from management.
Project Management:
- Handle projects and system-related issues.
Incident Reporting:
- Report incidents to the onshore team in a timely manner.
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.
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