Head of Claims

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

The Head of Claims is responsible for providing leadership to the end-to-end claims process for both individual policies and employee group benefit claims.

Job Description:

Claims Operations

• Oversee the processing of medical and life insurance claims for individual policies and employee group benefits.
• Ensure productive, timely, and accurate processing of pay and file claims and cashless guarantee letter admissions.
• Develop and implement claims management strategies to improve efficiency and customer satisfaction.
• Develop and maintain staff rosters ensuring optimal coverage and compliance with labor laws.
• Conduct fraud investigations in a timely manner.

Team Leadership

• Lead and manage the claims operations team, including claims processors, investigators, and support staff.
• Provide training, mentorship, and performance evaluations to team members.
• Foster a collaborative and high-performance work environment.

Operational Excellence

• Streamline claims processing workflows to enhance productivity and reduce turnaround times.
• Implement best practices and continuous improvement initiatives in claims operations.
• Monitor key performance indicators (KPIs) and ensure compliance with regulatory requirements.

Customer Services

• Ensure a customer-centric approach in all claims handling processes.
• Address and resolve escalated claims issues and customer complaints.
• Collaborate with customer service teams to enhance the overall customer experience.

Stakeholder Management

• Collaborate with internal and external stakeholders, including underwriters, brokers, and healthcare providers.
• Maintain strong relationships with key partners to facilitate smooth claims processing.
• Represent the claims department in meetings and industry forums.

Reporting and Analysis

• Prepare and present regular reports on claims performance, trends, and areas for improvement.
• Utilize data analytics to drive decision-making and strategic planning.
• Ensure accurate and timely reporting to senior management.
• Manage the claims budget and ensure cost-effective operations.

Project Management

• Ensure smooth system migration for product rollout, timely UAT, and operations enhancement.

Qualification and Experience:

• Bachelor's degree in Business Administration, Insurance/Takaful, or a related field.
• A minimum of 8-10 years of experience in operation management, preferably in medical insurance operations, with at least 5-10 years in a leadership role.
• In-depth knowledge of medical and life insurance claims operations.
• Strong leadership and team management skills.
• Excellent analytical and problem-solving abilities.
• Exceptional communication and interpersonal skills.
• Proficiency in claims management software and data analytics tools.
• Experience in strategic planning and execution.
• A commitment to customer service excellence.
• Financial acumen.
• Knowledge of compliance and regulatory requirements.