Executive, Claims

Prudential's purpose is to be partners for every life and protectors for every future.

ROLE PURPOSE: Provide dedicated claims services to claimants and Financial Service Consultants by ensuring delivery of key service objectives through efficient and effective claims management.

ROLE DUTIES & RESPONSIBILITIES: This role is accountable and responsible for the following:

• Adjudicate Accident & Health (A&H) claims and ensure delivery of prudent and equitable claims decision within expected service level.
• Ensure compliance with regulatory requirements, corporate guidelines, policy wording, and reinsurance terms.
• Manage claims investigation by working with claimants, financial consultants, medical institutions, insurers, etc. to determine claims decision and payment.
• Follow up on outstanding requirements needed for claims adjudication through documented follow-up process and provide regular update on claims status.
• Work closely with other business units to ensure that claims are processed accurately and that all service level agreements are met.
• Manage enquiries and appeals arising from claims.
• Support the team in implementing system enhancements or projects.

KEY PERFORMANCE INDICATORS: Improving the customer's Instant experiences on claims by:

• Ensuring that the claims are processed within the expected service level;
• Attaining the benchmarked targets for productivity, claims pending rate, suspense management rate

COMPETENCIES & PERSONAL TRAITS:

• Excellent communication, interpersonal, and problem-solving skills with ability to investigate, evaluate, and reach an appropriate decision
• Customer-centric with ability to work under pressure
• Self-motivated and able to work independently
• Team player, mature, with excellent leadership quality.
• Good medical knowledge and claims settlement procedure.
• Ability to read basic Chinese will be advantageous